A capabilities approach to housing and support

I’m speaking at the National Housing Federation conference this year (link below). Here’s my blog ahead of the event which you can also find here: http://www.housing.org.uk/media/blog/a-person-centred-service-means-focusing-on-capacity-not-need/ 

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The challenge laid down by the Care Act, which reframes social care from responding to a list of medical conditions to creating ‘wellbeing’, is for every public service intervention to be effective at meeting need, but framed around the person’s idea of a good life and their capacity to build it with those closest to them.

13 April 2015

Arthur is an older man with a number of co-morbidities and extreme anxiety. He makes numerous inappropriate calls to the ambulance service which waste valuable resources, but struggles to engage with interventions to address this behaviour.

Arthur is a keen and expert angler, with a gift for teaching his skills to others. He is happy to give his time to help others learn how to fish.

Both of those are factually correct descriptions of ‘Arthur’, but they lead us in very different directions. The first sees Arthur exclusively in terms of his needs and problems and presents services with a challenge in terms of how to manage his behaviour. Perhaps Arthur needs more medication or intensive mental health outreach work?

Fortunately, professionals took a capabilities-based or asset-based approach to supporting Arthur. They got to know him well enough to find out what is important to him and what he enjoys. Some agencies would then find a volunteer to take him fishing, but in this case, they found people who wanted to learn to fish from Arthur. Arthur no longer calls out ambulances unnecessarily, but rather than one service dependence being replaced by another (drugs or more intensive support), Arthur has found a role in which he is valued and helps others.

This is the difference between a simplistic view of personalisation, in which the challenge is to tailor services to individual needs, and a genuinely person-centred approach, which stays focused on questions which are meaningful to people: What does a good life look like? How can we achieve it? An approach can only be holistic if it can comprehend an individual’s capabilities and potential as well as their needs. Many younger disabled people lack employment. Many older people with high support needs can feel that they lack a meaningful role. For Arthur, the key to meeting his needs was to set them to one side for a moment, and focus instead on finding that meaningful role.

A number of approaches, such as Local Area Coordination, Village Agents and Community Navigators, are examples of how to build this thinking into the ‘front end’ of the public service system. The Care Act reshapes care assessment to look at people’s goals and capabilities as well as their eligible needs. Even where people have higher support needs, interventions can be shaped around their capacity.

For instance, around 8,000 Shared Lives carers are trained, approved and supported by a CQC-registered local scheme, then matched with an adult who needs support. They then share family and community life. Many adults with learning disabilities or mental health problems live with their chosen Shared Lives carer as part of the Shared Lives carer’s household, either for a short period to put down roots before getting their own place in the local area, or as a long term arrangement. Others, such as people with dementia, become regular visitor at their Shared Lives carer’s house, for day support or short breaks. The approach combines regulated personal care from a paid and trained Shared Lives carer, with the sense of belonging and purpose which comes from being a valued member of the household. Shared Lives carers typically say, “She/he is just part of the family” and the household aims to feel like ordinary life, rather than a service.

There are now over 12,000 receiving support from a Shared Lives arrangement, but it remains little known. The challenge laid down by the Care Act, which reframes social care from responding to a list of medical conditions to creating ‘wellbeing’, is for every public service intervention to be effective at meeting need, but framed around the person’s idea of a good life and their capacity to build it with those closest to them.

Alex will be speaking on redesigning services around the abilities and strengths of clients at the National Housing Federation Care and Support conference on 17 June 2015 in Birmingham. Click here to find out more and download the programme.

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