Danger

One of the ironies of safeguarding practice, is that when it’s not done well, it can bring new risks into people’s lives at their most vulnerable times. This is partly because there is – almost inevitably – a power imbalance in any safeguarding process: it’s a time when professionals exert their power, often under pressure and at high speed, and when people can feel like they are least well-listened to, and have fewest choices.

Safeguarding situations are supposed to be when everyone’s focus is on the risks facing the individual, but these situations also feel risky to the professionals carrying them out. It can be career-ending to get a safeguarding decision wrong, and conscientious professionals live with the anxiety of someone suffering preventable harm ‘on their watch’. When professionals and people who use services are both scared, it’s the fear of the person with most power – the professional – which wins out. Social care making safeguarding personal guidance aims to put the focus on the individual’s wishes and best interests, but where professionals’ own fears, and power, remain unspoken, it can be difficult to achieve a genuinely personalised and asset-based approach to safeguarding.

Safeguarding incidents are far rarer within Shared Lives than in other kinds of support (according to safeguarding data from care and health inspectors, CQC), but when concerns are raised, they are not always responded to well. Shared Lives draws on elements of both a service and of family life, with Shared Lives carers taking on a role that is at once professional and personal. The model draws its strength from that unusual combination but (as I wrote about in my book) it means it exists in an ambiguous (liminal) zone between service-land and private life, where professionals can feel dangerously lost as they try to follow rules which don’t quite fit.

Samir (name and identifying details changed) has lived happily for many years in a Shared Lives arrangement, with Maya who supports him with autism, a learning disability and health care needs. There is a busy road outside their house and after breakfast Samir, who needs support with travelling safely, usually sits in a room facing the street waiting to be picked up for his daytime activities. As in many houses, the front door is kept locked for security. Sometimes Samir finds it funny to sneak out and walk to his daytime activities, without telling anyone he has gone. Last time he did this, Maya immediately phoned ahead to say Samir would be arriving on foot and asked them to contact her when he arrived. He got there safely but did not come home.

A future for social care?

Here is my blog for Social Care Futures, the event and movement which will be based around a gathering in Manchester, alongside but independent of the annual National Children and Adults Services conference:

What do you do when the cause you are campaigning for fails to register with the public? When it is at best misunderstood or seen as one of life’s necessary evils and at worst seen as a permanent bad news generator, peppered with crises?

That’s the rather depressing problem facing campaigners for a better valued, better funded social care system. None of those public perceptions are fair. We can all quote stories of great social care, of lives being changed by sheer creativity, of inspirational compassion and, in my view, of some of the most radical transformation of any public service sector. But polls, focus groups and research agree: the public is still very hazy about what social care is, with those who do have an idea tending to believe it’s something provided free on the NHS. Social care is only guaranteed to make the news when it is being talked about as going bust, or when there has been an abuse scandal.

It was fascinating then, to be in a crowded room with the organisers and supporters of Social Care Future, the gathering planned to take place in parallel to the annual National Children and Adults Services conference in Manchester. We were hearing from The Frameworks Institute about their ground-breaking work with Joseph Rowntree Foundation (JRF) on reframing the issue of poverty and how to tackle it. The public has some well-worn and cliched ideas about poverty, including that it’s often do with people’s bad choices, including people who could work choosing not to, that there’s no such thing as ‘real’ poverty in the UK any more. Research shows that these are not true: poverty is real and can be desperate, people are born into and trapped in poverty, by low paid work and rising housing costs as much as worklessness, and so on. But messages about poverty as a problem, even a crisis, were not cutting through, even though they were based on real evidence, painstakingly gathered, because humans don’t easily change our deeply-felt beliefs through hearing facts, statistics or reasoned arguments. But reframing the issue of poverty has made a real difference to how JRF could get its research-based messages through to different audiences. The reframing process (set out here) includes appealing to people’s values, rather than relying on economic or other more abstract arguments: poverty ‘just isn’t right’ and shouldn’t be happening in a decent society. It also involved using some simple, visual images that make sense to people. In the case of poverty, JRF used ‘restricts and restraints’: poverty is rarely the result solely of bad choices: inequality and the hard end of our economy keeps hard-working people trapped in low incomes. They also used the idea of strong currents – the low wage, high housing cost economy, and life events like becoming disabled – which people cannot swim against however hard they try.

It was a compelling presentation about a successful campaign, whose messages could be found in previously indifferent or hostile papers. So what should we take from it for social care?

Firstly, that, whilst the crisis in social care is real and causing misery and suffering, if that is all the public hear about social care, it may not be motivating people and the politicians they elect to aim for change. In fact, a message that something is in permanent crisis, particularly when the public is unclear or ambivalent about it in the first place, may create a sense of hopelessness: nothing can fix it, so why throw good money after bad? That can’t be to say that stories about the crisis shouldn’t be told, but it suggests we also need a strong, consistent story about the good that social care does. We need to offer people solutions to the crisis – not just solutions to public service economic problems but also showing how social care is the solution to life events which any of us could experience ourselves or in our families.

There were two exciting and hopeful lessons from the session for me. One is that the flip side of the public not understanding and engaging with social care is that we – the social care sector – create and control a lot of the messages. We don’t have to compete with deeply, embedded or oft-repeated unhelpful messages, we just have to get our own messages right. Secondly, that we have all the elements that are needed to change people’s minds: social care is vital, is delivered by caring people and can transform lives. The vast majority would agree that supporting disabled and older people to live good lives is simply the right thing to do: we can appeal to that sense of fairness. And we have

Feeling important

“Feeling important is awesome. I want everyone to feel important.” Nick, one of our Ambassadors opened our annual conference alongside the incoming President of ADASS, Margaret Willcox as co-chairs and instantly had the whole room of Shared Lives and Homeshare colleagues and participants engaged. He was talking about the experience of working with Shared Lives Plus as an Ambassador, doing work which makes a difference, as well as about the feeling of belonging and mattering that is at the heart of all good Shared Lives.

At the annual social services conference the week before, I’d enjoyed, as I do each year, catching up with a huge number of colleagues, making new links and learning about some of the most interesting initiatives around the country (not to mention being rubbish in the annual quiz). But a question from a parent of a disabled daughter stuck with me: “I’ve been looking at all these sessions and discussions and wondering where I will find my daughter in them?” The conference did include a small number of sessions led by people with lived experience including the launch of a new model of ‘coproduction’ from the group of people with lived experience at the heart of the Think Local, Act Personal partnership and an inspiring fringe event with DanceSyndrome and Community Catalysts. But in too many of the main sessions there was a yawning gap between the discussion’s topic and participants and the people whose lives were being discussed. When you put a lot of ‘important’ people together, it can be easy to lose sight of what and who is really important. As Nick told us at our event, it’s great feeling important but that feeling should be for everyone.

Our conference now attracts Shared Lives carers and people using Shared Lives, as well as one or two family members and there are sessions which are designed particularly with them in mind, but I suspect that they will at times have felt that gap in some of the discussions at our event too. Involving people who use Shared Lives and Shared Lives carers as speakers, co-chairs and part of the support team has made a huge difference and hopefully prevents us from straying too far from what we are all supposed to be about, but we know we have further to go. Now that our conference has a Homeshare strand for the first time, we are also starting to think about how people who live in Homeshare households can be a part of future events.

Coproduction, as experts like Clenton Farquharson will tell you, is a journey. If you think you’ve arrived, you’ve probably just stopped. At our event, I was immensely proud of the work that we do, of our team and the membership network of which we are a part. It’s rare I think to be at an event for 200+ which feels both nationally important and ‘like family’ as one participant put it, not to mention smoothly run by our amazing office team. But it’s important I think to keep asking ourselves: where are the people who we are talking about in these discussions? If they are in the room, leading those discussions, having helped to design them, the answer to that question is much more likely to be clear to everyone.

Five questions with one answer.

On Friday, a group of senior leaders from council social services departments got together with colleagues from the Department of Health team writing the social care White Paper due later in the Spring. Sue Bott from Disability Rights UK and I did our best to keep order in a passionate debate about how to tackle a question as old as social care: what role should the state play in helping people to help themselves and each other? Peter Hay, this year’s ADASS President and social services Director for Birmingham, opened and closed the discussion and outlined a situation common to lots of areas: demand for services increasing whilst budgets shrink, coupled with recognition that even the best services cannot meet some of the most pressing needs, like isolation or exclusion from community life or employment opportunities.

I felt privileged to listen to the risks which local leaders are taking to turn a dysfunctional system on its head: it’s so very easy to panic and take a short term view when faced with a crisis in funding, but there are places around the country who have refused that easy option. There will soon be an open call for examples of citizen-led approaches to care and support, to which I’d encourage anyone with knowledge of promising local work to respond. But in the meantime, by way of processing some of what I heard and hopefully widening the debate, this blog and one or two following will set out some of the questions we kept returning to.

My first observation is that

You can’t specify love in a contract

Every year NAAPS hosts a week-long Shared Lives carer break at Ribby Hall for about 40 Shared Lives households. This year I was privileged to spend a little time with some of the Shared Lives carers and service users, who were having a fantastic time despite some lively weather! A very big thank you from all us to the many volunteers from Shared Lives schemes who helped to support service users and make the whole week possible.

This year, the week included a one day Shared Lives carer conference. We wanted to hold an event just for Shared Lives carers as our other meetings can be dominated by the issues brought by scheme managers and workers. We also held our AGM at the conference and voted to change our name – the new name will be launched on October 19^th, so watch this space!

Director of Lancashire Adult Services and immediate past President of the Association of Directors of Adult Social Services (ADASS), Richard Jones, spoke powerfully at the event about the value of Shared Lives and its important place in the future of social care.

Richard said: “There’s a notion around that we can do more for less, but trying to do more and more of the same for less and less money only gets you so far. We are learning three things. Firstly, that we must move away from the idea that all we need to do is offer a service. People don’t want services, they want to live a life, to be active citizens, to have a job or education, to give something back. Secondly, most social care is provided by families and communities, not the state, so its crucial that services work with those networks. Thirdly, that agencies, particularly health and social care but also many others, need to work together much, much better.”

Richard believes that Shared Lives is different. “You are helping people to achieve very different outcomes to the traditional, helping people become active citizens. Shared Lives outperforms a whole range of other services on quality, outcomes and value, because Shared Lives carers have a different relationship. In other services things vary according to who is on duty; in Shared Lives the individual is part of the family. You can’t write love into a service specification. I recently met ‘M’. He didn’t know what a family was

Care: industrial scale or cottage industry?

There are, we are often reminded, 30,000 residents in Southern Cross’s care homes. There is an argument about to what extent it would affect those residents if Southern Cross’s approach to funding its expansion, which relied heavily upon property speculation during the boom, ultimately led to its demise as a company.

Some people say it wouldn’t make any difference to residents – if a care home is viable it will simply be sold on to another provider. The Association of Directors of Adult Social Services have emphasised the need for councils to continue sending residents to Southern Cross homes to keep the company afloat.

But if it makes no difference to residents whether or not the company stays afloat, then why does it matter if it continues to have enough ‘customers’? Whereas, if Southern Cross going bankrupt will make a difference to them, then it cannot be in an individual’s interests to be “sent” to one of their homes. 

Individuals are not commodities, to be traded by councils and care providers, even in the interests of what might be considered the greater good. Councils are under an obligation to individually assess older people and to support them to make the best choices about care for them. A blanket recommendation to push people towards a care provider which may not be able to offer stability is unacceptable.

I think it’s hard to maintain the argument that residents have nothing to fear from Southern Cross going bankrupt. In order to attempt to stay afloat, the company has just cut 3,000 front line caring jobs. In other words, here we have yet another situation in which rash decisions made in order to maximise profits result in negative consequences for people who had no part in those decisions. It was of course, those residents’ money (or in the case of those whose care was state-funded, taxpayers’ money), which was hived off in the good years into the pockets of bosses and shareholders.

The Southern Cross crisis, coupled with the Winterbourne abuse scandal uncovered by BBC’s Panorama, should initiate a pause for thought about the relative risks and benefits of industrial scale care and support

Social work Chief talks about Shared Lives

Thanks to the 90 odd members who joined us in a cold and occasionally snowy Newcastle for a very successful conference and the AGM. Our annual report is now on the website.

Richard Jones, President of ADASS, was our keynote speaker and met a group of attendees for a discussion session, as well as mingling at lunchtime. What Richard said about Shared Lives (condensed a little!) was very interesting: “Too often we fit people into services, when what they want are relationships. We need to see and treat people as citizens, not clients, customers or service users. Shared Lives levers in so many community resources. It is a win-win service for people, families and the public purse. It often offers something others can’t: you can’t specify love in a contract.”

It’s a brave professional who talks about love and social care in the same sentence