At the Local Area Coordination Day in Derby, people from social care organisations like us and around a dozen councils heard from Eddie Bartnik, mental health commissioner from Western Australia (WA), who took time out from his holiday to give a personal perspective on how he helped to develop Local Area Coordination as the basis of reforming the entire WA care, support and inclusion system in the late ‘80s. That reform rejected the starting point of “What services do you need?” and started with “What would you consider a good life?” The principles were: personal, local and accountable (which sounds encouragingly close to the ethos of our own, Think Local, Act Personal).
The different attitude of a Local Area Coordinator was summed up by the work of an LAC who came across a number of isolated and stressed Mums of disabled children. The traditional response would be counselling, advice and respite. The LAC response was to bring those parents together: the formed a group they called Recharge. The LAC helped them to find an accessible leisure centre and negotiated with the centre that it would make its activities accessible to their children, whilst the parents took fitness classes and socialised. The cost was low and the benefits multiple: not just to the parents who were able to offload, get some exercise and have some fun; to the children who were now included in new activities, but also the staff and the centre which learned how to become accessible. A key lesson was to base LACs outside of state agencies, but with a link into the state system – and easy access to small amounts of money – when they need it. As one UK LAC at the event put it, we won’t take referrals, with the implications of a transfer of power associated with that, but anyone can introduce us to people.
One project in WA looked at how to help people with a significant impairment to live in an ordinary home. They have developed a community living placemat which sets out the building blocks including support, info, planning, supportive family and friends, building opportunities to explore and work towards goals, developing partnerships. Using this tool, they moved away from a choice between “you do it all” or “we’ll do it all” and instead helped people to bring their own resources – which sometimes included money and housing which people had long wanted to use but couldn’t get support to – into play in a coordinated way, such as developing shared living approaches.
Eddie outlined some rules for reform. In no particular order, these are the ones I picked up, paraphrased in some cases:
- Ask, what kinds of relationships would you aim for if you started ‘social care’ again? We wouldn’t start from here.
- Getting to know whole person well over time creates the possibility of speedier change later on. Move too quickly early on and all you will have is false starts.
- You won’t understand and meet people’s needs, if their needs are all you are interested in.
- We all use our natural networks to help us find jobs, social activities and other opportunities which we use to make a life. Services are a poor replacement for these networks for isolated people, particularly when that isolation is caused or exacerbated by a building-based service.
- ‘Contribution’ is the most neglected concept in public services. Well being comes from what we are able to contribute. Start with high expectations.
- People have ‘natural authority’ – respect it. Too often, services can feel like they are dismantling your life and offering it back, bit by bit, on their terms.
- We need to turn fixed assets into flexible assets. Services can do lots of vital things but can’t provide love, belonging, community.
Neil, who manages LAC in Derby, described how the approach has worked for a number of individuals, including an elderly man who had lost control of his overgrown garden and his house. When the LAC persuaded some people he’d met to help clear the garden, neighbours who had previously only interacted with the man through complaining came over to offer help. The complaints were the only response they could think of or felt confident to offer as ways of expressing their concern. Another elderly lady was struggling to keep on top of her house and had become isolated following the death of her husband. She was about to move into residential care away from the area. One problem identified was dealing with letters which she struggled to read. The first solution was an expensive piece of kit which read letters for her, which she didn’t use. The successful solution was reaching out to a neighbour who was happy to help her with her post. She’d wanted a human, not a machine, but it had taken everyone a little while to hear and know how to respond to her loneliness. That was one of many links which she started to rediscover and make and she now lives without any formal support.
There are just under 10,000 people directed supported by 150 LACs in Western Australia (1 LAC: 50-65 people). The average cost was just under €2,000 per person. 20 evaluations since 1988 have consistently found it to be low bureaucracy, low per capita cost, strong on prevention and ‘multiplier’ effects (added value), low on opportunity cost. A major evaluation found that the “LAC model provides value-for-money outcomes not matched by any other areas of disability services delivery” and that “the operational costs of LAC have remained relatively stable over time, compared with other forms of service delivery.” You can find links to these evaluations at www.inclusiveneighbourhoods.co.uk. LAC is now being implemented across Australia and across the UK among other nations. Its ethos is evident throughout the Care Bill currently going through parliament here.