Reverse auctions

We live in a society which auctions the care of disabled and older people. Not to the highest, but to the lowest bidder.

This has been going for years. Sector leaders have long condemned the concept of ‘reverse auctions’ for care packages, in which a homecare or other support contract is won by the lowest bidding care provider, but care contracts can still be put out to tender using a scoring system which puts lowest price as the most important factor and the Care Provider Alliance expressed concern about this issue again this year. In other areas, when an individual is assessed as needing support, a pen portrait of their needs is circulated to care providers approved to be on the local area’s ‘dynamic purchasing system’ and those providers bid for that care package. Again, lowest price is at least one factor in their bids and providers have reported feeling that the real extent of someone’s support needs have not been made fully clear, meaning that the care package offered will not meet their needs. In some areas, only one ‘affordable’ option is presented to the individual who may not realise they are not obliged to take it. These auctions are presentable as offering ‘choice and control’ to the individual, despite the obvious limitations on that choice. Any provider which achieves a certain ‘quality score’ can enter the framework and be on the list, but it is easy inadvertently to set conditions on quality which effectively eliminate innovative and start-up services which may not have a track record of providing conventional care. (This is why the duty on councils to develop diverse provider market places in the Care Act is so important: its implementation needs much more attention.)

This was not what was envisaged by disabled people and their families who developed personalisation, which was the idea that people would plan the most effective care and support when they were in control of an individual planning process which started with what a good life looked like, not with a list of low-cost services. Planning creatively in this way enables people to make best use of their own capacity and of the family and community resources available to them. That also usually results in the most independence and lowest overall cost to the state, whereas narrow price-focused processes bring missed opportunities for independence, or lead to family care breaking down. But instead of people planning a life, and then choosing the support they need to live it, care providers in some places now compete for the individual, and an algorithm makes the choice. (Approaches like TLAP’s Making It Real are designed to push back against this kind of pretend personalisation.)

The Shared Lives model is resistant to that kind of automation, partly because it is based on matching the individual with a specific Shared Lives carer: both parties meet and make a choice to share their lives with each other before any support package starts. That resistance can be a double-edged sword though: if Shared Lives looks too complicated or ‘messy’ to include on an area’s shiny new system, it may just be omitted from the choices offered to people. In one area, commissioners have apparently described Shared Lives as a ‘luxury’ model, despite the overall package being demonstrably lower cost than traditional equivalents, sometimes by tens of thousands of pounds.

These problems are not just a symptom of the lack of money available to pay for care providers. They are also symptomatic of cuts to the teams which plan and buy care on behalf of us all. Experienced commissioners who understand how social care works are more likely to be able to recognise the value of truly personalised support and to think through the consequences of cut-price care, which can rapidly lead to a crisis and expensive medical care.

Most of us do not have to contemplate what it would be like to have a price put on our happiness, safety or dignity. There has never been greater pressure upon price in our public services. We can’t rely upon algorithms to deliver good lives: we need to develop care navigation and brokerage teams who can help people make good choices, and which can help to build community approaches like Shared Lives. People who need support will be more likely to achieve real value for money within local marketplaces, where people and local providers can connect with each other, rather than left adrift in virtual ‘emarketplaces’ or to the free market.  And we should simply outlaw processes which put lowest price first.

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The canary in the coalmine

This is an extract from a blog from Ben Hall, who leads our Scotland development work. Ben and our new colleague Lesley Stevenson are working with Scotland’s Shared Lives schemes and our partner organisations to demonstrate that Shared Lives can be a viable, national alternative to models which are coming under increasing pressure in Scotland, as across the UK. Ben writes:

17,000 people who live in, or receive care from Britain’s second largest care home operator, Four Seasons, are today left in doubt about where they live, as the private equity firm Terra Firma pleads with lenders to approve a financial rescue package for it. Four Seasons was saddled with huge debts to its own owners after they bought the care provider in 2012. This £220m debt, loaned at 15%, will earn Terra Firma £660m by 2022. The financial struggles emerged today as part of the Paradise Papers leaks.

But it is the small signs, like the canary in the coalmine, that we need to listen to. Last week, Bield Housing, a high quality care provider, made the decision to withdraw from running residential care homes across Scotland, on the basis that this is no longer a viable financial business due to falling funding from local authorities.

The decision by Bield, although small by comparison, is the more profound. When a high quality provider walks away from an industry saying it is uneconomic, then our national leaders need to listen.

These two very different examples show, more clearly than ever, that we need new ways of caring in order to provide the dignity and care to our older family members.

Read the full article here.

Stroke survivor Brian gets ready to move on

This story from Shared Lives South West shows how Shared Lives is providing great health care as well as social care. The story can be found here. It’s a great contrast with the story about room renting which hit the headlines last week – see my previous blog. We are working with NHS England and 7 local NHS CCGs to develop new health care options. Here is an extract from the full story with thanks to Shared Lives South West, who continue to inspire us all:

If you rewind a year, Brian Lee’s future looked bleak. While out walking in local woods he had a stroke and ended up in intensive care and endured a four-month hospital stay.
His health deteriorated further while in hospital as he also suffered two minor heart attacks and Brian was extremely weak.

The medical trauma left him with complete memory loss and his mobility was severely compromised- making it difficult for him to walk even short distances.

Fast forward to now and his life couldn’t be more different.  Thanks to the support and care he’s received from the Shared Lives team and ultimately his Shared Lives carers Jeanette and Alan Eames as well as his own determination, Brian is well on the road to recovery.

He’s recently managed to plan and go on holiday to Thailand and is preparing to move out to his own flat and live independently.

“I was so stubborn and determined. I had to prove to myself that I can still do things,” said Brian.

“Jeanette and Alan have helped me through it all. I was decrepit feeble creature when I arrived at their home in March.

“I couldn’t walk down the drive, now I can nip up to town. I never dreamt of being so independent again when I came out hospital.

Since moving in with the Eames’ family, near Okehampton, they have been there to support him every step of the way-  from helping him with appointments to liaising with his friends to help him move forward and sorting his medication and preparing him for his trip to Thailand, where he visited with no support. It was paramount his carers got him ready for the trip and made sure he was able to manage all his medication.

The Shared Lives team were also on hand to make the match with the Eames family. They charity’s Funding and Benefits team also maximised his benefits.

“They prepared me and made me ready for life outside,” said Brian.

“I think what was most important to me was to realise limitations early on, then I think you have to scale back on your expectations, then you can move forward positively.
“The main help was with my medication, that was a key thing. With Jeanette’s help there were visits to the doctors to make sure my balance of medication was right, as when I came out of hospital it was all wrong.

“I was on knock-out drops, I wasn’t living life as it should be. By 11am I wanted to go back to sleep again. I spent most of my time just sleeping. It was too much and there was a real temptation not to take them.

“Jeanette got it sorted out for me.”

“I also made sure he was taking the right medication at the right times to start. Now he has pots and has hang of doing it all himself,” said Jeanette.

Banking also became difficult as he struggled to remember numbers.

“If you ask me about a phone number or bank details and I wouldn’t have a clue,” he said.

With advise from Jeanette, they decided to change passwords to key dates that he could remember.

“That way I could do somethings myself with support,” said Brian.

The full story is here.

Ken the artist: Part 2

I shared Ken’s story courtesy of the Medway Shared Lives scheme a few days ago. I see that Ken and household have also been visited by government Minister, Tracey Crouch MP, who wrote on her Facebook page on 8 September:

I met two incredibly inspiring local ladies today – Sarah and Vicky. What is so special about them is they are carers with Medway Shared Lives, a brilliant initiative that is operated by local authorities across the country which provides longterm, short term or emergency homes for vulnerable adults.

Sarah invited me to their home to tell me about Shared Lives and what they do, the value they bring (both in terms of to the individual emotionally but also to local authorities financially) and of course the challenges they face. It was comforting to hear that Medway Council – Service updates and information has recently demonstrated their commitment to the scheme with a welcome increase in carer rates after several years of none. I met Stella (53) and Ken (70) who both have a learning disability and who Sarah and Vicky have hosted now for several years. It is as if they are part of the family and you could tell instantly that both Stella and Ken are settled and very happy.

I think the scheme is a brilliant idea and I wanted to take this opportunity to promote it more widely. If you think you could host an adult who needs just that little bit extra support so they can live independently rather than go into a residential care home, then please do click on one of these links:

http://www.medway.gov.uk/…/car…/becomeasharedlivescarer.aspx

http://www.kent.gov.uk/jobs/become-a-shared-lives-host

https://sharedlivesplus.org.uk/

Caroline’s story

This story was told to us by Sara Podmore who manages the Telford and Wrekin Shared Lives scheme:

Caroline, 26, had been in the Navy. She was being severely bullied whilst training to be a medic. She was initially thrown out of the Navy but after support from charity, Combat Stress, the Navy now supports her in getting help and treatment with severe depression, OCD and post-traumatic stress.

Initially Caroline had been allocated to a support worker in a supported living set up. She had some hours support each week but this was predominantly to help with paperwork. “I wasn’t well, I was basically put into the house and left. I ended up taking a massive overdose and then ended up being sectioned.

I had never heard of Shared Lives and my social work ended up introducing me to Linda and Owen, I don’t remember much from this time but I remember coming round for tea visits before moving in. This was April 2013.”

The Shared Lives team felt that Linda has the listening skills that would be needed to support Caroline through this period of her life. Shared Lives worker, Cath, vividly remembers those first visits. “Caroline looked so small, curled up on the sofa crying looking ill. She was in what looked like a trance. She really didn’t care.”

Caroline describes her OCD: “I stroke the light switches, I check the doors all the time. It’s better to laugh about it if I can. Linda tells me to leave it and she will check it, this really helps, otherwise I would sit by the door all night.”

Caroline says of her first few weeks living with Linda, “The family were so welcoming; it was amazing to be part of the family. I settled in really quickly. I didn’t feel like I was treading on eggshells, there was no pressure. I felt I could approach the carer and they would be non- judgemental.

“In that time I feel my confidence has changed. I’ve got a strength I’ve never had, I’ve had lots of encouragement, I’ve talked for hours with the carers, there is no such word as ‘can’t’.  I do a lot of laughing. I’ve slowly come off some of my medication too in the time I’ve been here which is great. I haven’t had any help from the mental team- Linda has been my mental health team, they have abandoned me. I’ve even managed to have contact again with my family. I see my mum again now who I couldn’t before as she couldn’t deal with me being ill. We do family holidays now too which is amazing.

“Now I work 26 hours a month and have completed my NVQ 2. I run now too. We all eat dinner together. Its important as I can chat, considering it’s their house its amazing they are always there for me. Things like Christmas are amazing we get so many gifts, I never expect it.

“At the very start of my journey I didn’t want to be in the world- but since coming into this placement it’s been great. I’ve not had a dip since I’ve been here and I’ve learnt to listen to my body.

I would tell other people when talking about Shared Lives: there is hope no matter how unhopeful you feel.”

Ken the artist

This is a guest blog in which my colleague Hannah tells Ken’s story, from the Medway Shared Lives scheme in Kent:

“We’re not staff, we don’t clock off after 8 hours, there’s no handover at 10pm, no rigid routines, and we can make sure people have an ordinary day, week, month and year.”

Ken who uses Shared Lives services joined Shared Lives carer, Sarah King in an emergency, unplanned placement in 2011. Sarah soon discovered there was more to Ken than meets the eye.

Ken has a moderate learning disability and needs support for all daily activities. However, this does not stop Ken from being popular in the community, and communicating with a variety of people, despite having a limited vocabulary.

Within a few weeks of Ken living with Sarah, she learnt that he was an artist by a chance meeting with Ken’s former tutor, who ran an art project Ken was involved with, and also a pottery class he attended regularly.

When Ken transferred to Shared Lives he didn’t tell Sarah about his art work. The college he attended thought he may have passed away, due to his unexplained long-term absence, so the reunion was very emotional for both Ken and his tutor.  Delighted to see Ken, the tutor said to Sarah, ‘You do know he’s an artist, don’t you?’

Shared Lives carer, Sarah King said: “We didn’t know… the only art material he brought with him was a child’s colouring book and some worn out felt tip pens. We set about trying to engage him in creative activities, at home and in the community. Several months later the care manager received an email about a new art project, which was to start the following week. Due to us being able to be flexible and responsive to needs and circumstances, I was able to make contact with the facilitators of the art project.  We looked at the workspace- so he joined for 1 day a week the following week.”

The 3 month art project gave Ken some really valuable art experience – he was valued as an artist by professionals in his own right. The art project held an exhibition at the end and Ken sold some great pieces of work at the final exhibition.

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Mystery and Bureaucracy

A twitter exchange between Rob Mitchell and Prof Chris Hatton put me in mind of the famous quote from L’Arche founder, Vanier: “Some people say that communities start in mystery and end in bureaucracy”.

Chris, a skilled combiner of academic rigour and humanity, said, ‘Bureaucracy is a vampire. It feeds on people’. Lots of people reading this blog will relate to that, perhaps because they will have felt their own lives drained by working within, or even living within, a public service bureaucracy. What is bureaucracy though?

We all come across bureaucracies. They feel inhuman: some are machine-like; some fanged as Chris says; some have tentacles which we feel reaching around us into our lives.

But a bureaucracy is always a group of people, choosing to behave in a certain way. People will dispute that word “choosing”. The nature of bureaucracies is that, whilst someone at some point wrote their rules, and other people added to them, they feel like they have come to life, operating beyond the control even of those who profess to lead to them.

But whilst Vanier’s quote is often read to mean that every community – a group of people who share some beliefs and ways of behaving – already has some bureaucracy in it, it also suggests that every bureaucracy is also a community.  He could equally have said that every community starts in mystery, and ends in mystery: the mystery of how a group of humans created something which feels so utterly unlike themselves.  The bigger the bureaucracy, the deeper its mystery: the gap between the values of the people within it and the way we feel instructed to behave. This is why I think the challenge facing public service leaders is no longer how to scale up (the business growth model of marketised public services) but how to scale down.

But even in a vast bureaucratic community, no rule is unchangeable, or incapable of more than one interpretation. The choice to be human can feel difficult, or downright dangerous, when we work within a bureaucracy, but nevertheless we make choices. Ultimately, then, the nature of a bureaucracy, lies in the choices the people within it make every day.