The brain injury service could not engage with him. Brain injury recovery is never easy when the patient has a different first language, and perhaps this was one of the reasons he was not engaging at all with the service, at a crucial time in the recovery process. This particular brain injury service was part of a partnership between NHS England, Shared Lives Plus and local NHS trusts to demonstrate Shared Lives as a health service, building on its 40 year history as the highest-performing form of social care. The solution they found was the kind of thing you cannot commission for in the traditional sense: the Shared Lives organisation found, trained and approved a Shared Lives carer who shared the same first language and who was able to build a relationship, and be the bridge between the service and the individual, providing the support and interventions developed by the NHS team and getting recovery back on track.
This is what personalised care looks like: unique, one-off, impossible to plan for or commission in the traditional sense of those words. That challenge – how to do the uniquely right thing over and over again for a whole population of unique individuals – has always been the paradox of scale that the NHS has struggled with. So it’s a huge step forward that today, NHS England launches its long-awaited Universal Personalised Care model, which sets out every area will be expected to develop and deliver personalised care as core business, reaching 2.5 million people. The model strikes a good balance, with enough detail on the standard operating model of key elements of personalised care, including personal health budgets, social prescribing, self-care and peer support, without being so prescriptive that local areas can’t co-produce a locally-tailored version of the model which has real buy in from citizens, as well as providers and commissioners.
We helped to develop the thinking behind personalised care, and the Shared Lives sector has long taken a similar approach: at Shared Lives Plus, we have worked with our members across the UK to co-design the policies, procedures, outcome measures, quality frameworks and so on, needed to ensure the regulated model is recognisable in the Highlands or Cornwall or Haringey. But we know that the power of the model is the autonomy which people have to live whatever a good life feels like to them. Shared Lives is identified in the Universal Personalised Care model as an approach which embodies that ethos. We have learned the hard way in social care that personal budgets are only powerful as a force for change, when there are new kinds of support waiting for people to buy with their budget, otherwise people get the same old thing, just with more responsibility to manage it. Advocacy and brokerage are vital to avoid new inequalities arising as some people have the confidence and networks to build new support, and others don’t. So I’m particularly pleased to see the investment in advocacy in new model.
It’s an exciting start and we’re looking forward to working with NHS England on scaling Shared Lives as part of a much deeper system change. There are currently over 900 people in England using Shared Lives as a health service: there should be 9,000, or more…..