What could be

Finally, social care is being recognised by our political leaders as vital to our nation’s health and wellbeing. All parties now recognise that ordinary people can be called upon to pay vast amounts towards their care, in contrast to our free-at-the-point-of-need NHS. There is public recognition of what social care is, for the first time. But now we need to visualise what it could be.

Our annual State of Shared Lives Sector reports give a glimpse of a possible future. They have consistently shown that Shared Lives is growing in England, and now we have evidence of new growth in all four home nations. They have also highlighted the difference Shared Lives makes to people’s lives. Many people who might otherwise have lived on their own or in a care home are finding a settled home with their chosen Shared Lives household. Meanwhile, a new group of older people and others who live with their families, but need regular overnight or daytime breaks, get those breaks from visiting their chosen Shared Lives carer, often matched with them because they both enjoy the same activities, rather than struggling with the stress and disruption which more institutionalised breaks services can bring. People live well and sometimes achieve the impossible.

This year our annual report for England (as reported in Community Care) paints both an encouraging and concerning picture. In previous years, Shared Lives has grown strongly, despite the cuts which are shrinking all other forms of social care. The net growth has been about 1000 additional people per year. This year, the number of people using Shared Lives in England has grown by around 580, to just under 12,000 people, around half of whom are living with their Shared Lives carer, and the other half are split between short breaks and daytime support. Look at the numbers of people using Shared Lives by region, however, and it is clear that there is a widening gap between those regions which are accelerating and those which have in previous years been stalled, and are now starting to slip back. So the regions which are growing, have added over 1,100 additional people. Half of this growth comes from the North West, with London and the South West splitting most of the rest. There are signs of growth in the North East, which has been one of the smallest regions and where we are working with directors’ association ADASS and the region’s Shared Lives schemes and partners to create a regional hub. The South East and Yorkshire have seen significant reductions, however, after having previously been regions which were using and developing Shared Lives strongly. The East and West Midlands remain essentially unchanged and the East of England, which has been the smallest region for some time, is now falling. Meanwhile, the model is growing in Scotland, Wales and Northern Ireland and we have embarked upon ambitious new programmes in each nation, with strong support from the Wales Government in particular.

With so much news about cuts and the crisis in the NHS, it is easy to believe that the future of public services will just be less of what we have now. But we believe Continue reading

Growth is the enemy of diversity?

Soon, all councils in England are going to have some new duties, thanks to the Care Bill which will become the law setting out what every area has to do when offering social care. I want to look at a couple of those duties in blogs over the coming weeks, starting with the duty to develop a diverse ‘market’ of care providers, so that people who can now take control of the money allocated to them to meet their social care needs have a real choice of different things to buy (otherwise, what’s the point in having a Direct Payment or personal budget?).

I can think of four kinds of ‘provider diversity’:

  • A range of approaches (eg you can choose Shared Lives not just care homes or home care)
  • A choice of providers (different organisations out there, even if they are doing some of the same things)
  • A range of scales of provider, from the security and infrastructure of going to a household name like Bupa, to the personal relationship of getting support from a tiny micro-enterprise which may have been set up specifically with you in mind
  • A choice of ownership model.

I’ve blogged before about the ways in which we at Shared Lives Plus and our sister organisation, Community Catalysts, are helping to bring Shared Lives and Homeshare into prominence as distinctly different social care approaches people have not previously been offered. Likewise, when it comes to diversity of scale, we’ve supported Community Catalysts in its extensive work to grow the micro-enterprise sector: Community Catalysts has supported 40 or so councils to develop micro-enterprise friendly areas; we have worked together with DH support to produce guides like last year’s guide to Commissioning for Provider Diversity. That work’s been successful in the areas which have bought into it, but we know that in most areas, the smallest micro-enterprises are very vulnerable to being inadvertently squashed out of existence, whilst at the other end of the spectrum, there are plenty of acquisitions and the average size of the larger providers is increasing, which suggests that the number of different organisations is decreasing, not growing as the Bill envisages.

So there are challenges in delivering each of those four kinds of provider diversity, but perhaps it’s the last of the four where there is almost no real activity or progress.

As long as we see ownership as being a public/private choice Continue reading

How to commission for a diverse range of providers

A guest blog from Simon Taylor (simon@sharedlivesplus.org.uk), who supports our micro-enterprise members:

When the Care Bill becomes law, commissioners will have a duty to promote a range of services that meet local people’s needs. This won’t be easy with tightening budgets and the drive to commission services ‘efficiently’, which many areas have seen in terms of having fewer contracts to manage. In addition, councils will have duties to support the development of preventative services and to help individuals to use Direct Payments and personal budgets to purchase support which is of their choosing.

Shared Lives Plus, supported by the Department of Health and endorsed by sector partnership Think Local Act Personal, has produced “Commissioning for Provider Diversity – A Guide”, which will help councils commission in a way which gets better value for money through having a wide range of local services, not just a few large contracts.

The report draws on the voices of the smallest of providers who deliver services at the ‘micro’ scale and on the work of our sister organisation, Community Catalysts, which supports local authorities to create the conditions in which micro as well as larger providers can thrive. The report explains the principles and then sets out the practical steps for commissioners to take, including identifying the met and unmet needs of personal budget holders and enabling citizens to have a say at every stage.

From our membership, we hear stories such as Continue reading