For the policy-minded folk out there, here is our response to the consultation which closes on Friday 28th about developing Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies (email JSNAandJHWS@dh.gsi.gov.uk to respond). For the non-policy interested, our key point is that, when they are planning, councils need to start looking for the hidden assets (eg community groups) within their areas, not just at what people’s needs are. They must get better at that too though, in particular they need to start trying to understand what personal budget holders and ‘self-funders’ (people who spend their own money on social care) want, need and get. Here’s the full version:
We are responding on the extent to which the proposals support the care and support White Paper aspirations to create a social care system based upon the principles of prevention, promoting well-being and fostering new partnerships between citizens, communities, services and the state.
The White Paper introduces the language of ‘assets approaches’ to social care, outlining how public services can become more productive and effective if they are co-produced with service users, families and communities. This is particularly relevant to the sphere of public health and the promotion of well-being: it is not possible to impose healthy lifestyles upon people or communities from the outside, but it is possible to provide people with the information, tools and peer support structures to make more informed and positive choices and to influence others positively.
To embed assets approaches within strategic planning for health and well-being, we strongly recommend that Joint Strategic Needs Assessments are reframed as Joint Strategic Needs and Assets Assessments, with guidance provided to authorities on involving citizens and community groups in mapping the whole range of assets available to them, as well as mapping the area’s needs. Many relevant assets are currently not known to strategic planners.
We feel that the draft guidance does not give a strong enough message on supporting citizens and community groups to be at the heart of commissioning and strategic planning. The guidance is still framed in terms of professionals consulting with citizens and then making decisions. This is out of step with the principles of localism, right to challenge and community rights enshrined in recent legislation.
For instance, when our sister organisation, Community Catalysts carries out mapping work as it has done in a range of local authority areas, it discovers in some cases dozens of micro-enterprises working in the health and care fields which have been previously unknown to councils. These include enterprises set up by people who use services, although, as set out in Shared Lives Plus/ Community Catalysts reports such as A Map for Micro-enterprise and Ten Ways to Stop Bashing and Start Boosting Micro-enterprise, we are only beginning to explore the potential for enterprises and services to be led and owned by people who use services.
The support, development and inclusion of user-led organisations needs also to be much more strongly and clearly set out as a key factor in producing a successful JSNA and HWBS. Assessments and strategies should have the goal of helping people who use services to act collectively, including through exercising their purchasing power, in order to shape the provider market. People with personal budgets and Direct Payments can exercise control over individual purchasing decisions through those means, but cannot individually shape the range of provision from which they can choose. Shaping the market requires support to act collectively. Accessible and flexible virtual marketplaces which bring together personal budget holders and existing and potential providers of all sizes will be an important part of achieving this. There is a need in most areas to gather information on the aspirations and met and unmet needs of personal budget holder and self-funders and few, if any areas have mechanisms in place with which to use such information to inform their JSNAs.
Most social care is provided by families (Carers UK estimate the current value of unpaid family care to dwarf the state’s contribution at well over £100bn pa). Family carers and their representatives are therefore one of the most important stakeholders in planning care and the state should recognise that in many cases its interventions will be effective only in as much as they support unpaid caring.
We recommend Local Area Coordination, among other Asset-Based Community Development approaches (see White Paper), as a well-developed and evidenced approach to finding and building community assets and resilience.
We also believe that Health and wellbeing boards should routinely include providers and move away from gladiatorial commissioner/ provider relationships to a more modern approach to commissioning and planning. Many authorities are overly risk-averse in their interpretation of EU procurement law in relationship to involving current and potential providers in strategic planning processes. The potential conflicts of interest in so doing are manageable.