A different relationship between people and services

Tim Fisher of Camden council hosted an inspirational day thinking about how to build different kinds of connections between people who need and offer support, at which I and colleagues, including our new peer Champions and people with lived experience of using Shared Lives were privileged to speak. Tim’s colleague, Martin Hampton, was kind enough to review my book for the Camden council social care newsletter. Martin writes:

Tim Fisher, Family Group Conference Service Manager, recently placed an insightful book on my desk entitled ‘A New Health and Care System – Escaping the Invisible Asylum’ by Alex Fox. It is no surprise to me that Tim recognised that Fox’s book is sympathetic to the principles of support and care within family group conferences, where relationships are central, nurtured and strengthened. Fox is cited in the 2019 Department of Health and Social Care ‘Strengths-based approach: Practice Framework and Practice Handbook’ and his book is a subtle and powerful addition to strengths based practice. The value of our public service resides in the people that use and provide the service, particularly the relationship between them and the health and wellbeing they create together.

In Fox’s radical book, he states that connecting people should be a mainstream goal of our public services as it is linked to heath, wellbeing and happiness, with isolation a serious health risk. Fox draws on evidence that loneliness leads to poor physical and mental-health and increases the risk of mortality (Holt-Lunstedet, 2010). He also cites evidence that nearly half of people over 85 admit to experiencing loneliness most of the time and highlights research showing that one in ten people visit their GP because they are lonely. He reminds us that loneliness in old age is not just miserable: loneliness is associated with risk. Particularly risk of falls, poor physical and mental health and higher risk of dying prematurely; all of which create further cost in the acute part of the system, and suck in an ever-increasing share of the available resources. Yet Fox evidences a UK Homecare Association Survey (2012) which found that 73% of home-care visits in England were shorter than the allotted time, many visits of 15 minutes (barely time to help a frail older person get up, washed, dressed, and fed). A Health Watch England 2017 Enquiry into Homecare found that people simply stated the obvious: ‘That care packages were designed to meet the needs of the service provider rather than the service user’ (Healthwatch, England (2017).

Fox’s book utilises London School of Economics research that found genuine preventative aspects to befriending and recognised the value of a relationship in supporting good mental-health and resilience. These interventions typically take an ‘asset-based’ approach: they help people to build their own strengths, capabilities and resilience and those of their families and friends (C Kapp, M., Bauer, A., Perkins, M. and Snell, T. (2011). Fox argues that Government should devolve responsibility and resource control to the most personal level possible, and then create ways for individuals, households and community to pool these resources and build towards a scale that works for them. Finally then, Fox leaves us with the profound idea of Shared Lives; a simple combination of ordinary people with the capacity to care and a spare hour with a local organisation ‘pool’ that can bring the right people together and monitor the results. I am sure there will be many examples of people thriving in Shared Lives projects, and it would be positive to start one in Camden. As Fox concludes, a person’s interaction with any support service is more cost-effective where both service and individual (or the family) bring their energy, time and creativity – and where they see success as a shared responsibility, not something one purely owes another. This only happens when workers and people form real relationships.

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