Serious about Shared Lives

This is a guest blog from my colleague Nick Gordon (nick@sharedlivesplus.org.uk) who works in our communications team and supports local Shared Lives providers and commissioners with their demographic analysis, marketing and recruitment. Nick writes:

With the anniversary of the pandemic hitting approaching, the vaccine roll-out offers hope, if not yet certainty of when ‘normal’ life will return. All we can be certain of is that ‘normal’ will not be what it was before. We will be in a period of huge challenges – long covid, mental ill health, ravaged economies – and huge changes to the way that we live, work and travel.

Throughout these extraordinary times, and despite enormous pressures on our health and social care systems, Shared Lives care has continued to shine, providing the safest and best quality form of care as rated by the CQC and amazing outcomes for people like Meg who have found connections deep enough to sustain them through the long period of social distancing.

Recently we have seen an increase in local authorities seeking our advice and guidance on how to grow Shared Lives services as part of a re-imagining of social care which many areas recognise cannot wait for a long-promised government plan for reform. Social care workforce recruitment is a longstanding challenge in a sector known for difficult work, low pay, low status and long hours. Shared Lives offers flexible, home-based work where people can focus on what matters to the person who comes to live with or visit them, and, having been through a unique, in-depth recruitment and matching process, are trusted enough to be freed from much of the unnecessary paperwork, rules and bureaucracy which prevent so many social care workers from being as caring, let alone as social, as they dreamed of being when they entered the profession.

Our strategic advice and support service is currently working with North East ADASS across 12 local authority areas to deliver a wide-ranging and ambitious growth plan, which addresses a common barrier for many Shared Lives providers: how to recruit new carers. As well as a cost-benefit analysis of existing activity, we’ll be delivering data-driven demographic customer profiling for existing carers, along with the design and delivery of a digitally-enabled marketing and communications strategy .

As well as growth, we can also work with local authority commissioners to help deliver a business case for Shared Lives in the first instance. Based on our work to date we have demonstrated an average £20,000 saving per live-in arrangement per year, when compared to other types of available support for people with similar levels of need.

Not only this, our recently announced National Lottery Community funded project is helping to embed a shared, online approach to recruiting and assessing potential Shared Lives carers,  from initial enquiry through to full vetting and training requirements. Launching in March this online portal will further streamline Shared Lives carer recruitment, maintaining an in-depth, values-based approach, but reducing recruitment and approval times from 4-6 months to 4-6 weeks.

Shared Lives is still a relatively small cog in the UK’s social care wheel, but with an average annual increase of 6% in Shared Lives live-in arrangements since 2012, we know we can grow the sector in the teeth of financial and demographic challenges. Now we are entering a period when there will unfortunately be thousands of people looking for work, and many more are already re-thinking what a good life looks like and what they want from their career. Flexible, rewarding, home-based and resilient during the pandemic: if national government, local councils and the new Integrated Care Systems are serious about radical change, it’s time to get serious about Shared Lives.

All health and care commissioners should demand social value

This is my blog to support the launch of the Joint VCSE Review’s new action plan. I have also written a piece for HSJ with Glen Garrod of ADASS and Rob Webster of South West Yorkshire Partnership NHS Trust.

“We welcome the new action plan from the Joint VCSE Review, which has set out an important vision in which voluntary, community and social enterprise organisations work with the NHS to co-design and co-deliver health and care services with local people. The action plan has a strong focus on greater use of Social Value Act powers by health and care commissioners which enables commissioners to seek added social value from local providers and more value for public money in partnership with charits and community groups. Use of the Act should be more routine in health commissioning.”

Simon Stevens, CEO, NHS England.

What do voluntary, community and social enterprise (VCSE) organisations want from government and the NHS? Ask our statutory partners and many will say, “money” and then add “but we don’t have any!” The first part of that is true, of course. The VCSE sector can often manage with less money than other kinds of organisation, because it is often better at drawing on different kinds of resources as well: people’s freely given time, support from local community and businesses, use of community resources. But all organisations working in health and social care, whether statutory, private or not for profit, need money to run. The difference between statutory and voluntary organisations is not their need for money, it is that typically statutory organisations control that money, and VCSE organisations do not.

Two years ago the Joint VCSE Review held a full consultation with the VCSE sector and its partners, and produced a report and 28 recommendations based on what we found. We heard that VCSE did not want to be in the position of asking for money: they wanted to share responsibility for the resources available, and to help people who use public services to share that responsibility. When statutory organisations and commissioners say ‘there’s no money!’ they have often started with the assumption that they must keep spending the money they have on what they already do. Local people, particularly from groups and communities who are not well-served by current services, can take a different view, if they have the opportunity to take part in genuine decision-making (as opposed to being ‘engaged’ and ‘consulted’ by decision-makers reluctant to give up any real power). So our key message was that, if we are serious about community-based, community-owned health and care services, which both expect and ask more of citizens, we need to get serious about co-designing those services with the people who make most use of them. VCSE organisations are the only ones with any track record of doing that. The fact that co-design and coproduction are still seen as slow, difficult and optional, rather than essential to improvement and tackling inequalities, is a good indicator of how much current commissioning teams need their voluntary counterparts and the communities they reach.

King’s Fund research commissioned in response to the Joint Review found a clear distinction between commissioners who co-commission and those who see their VCSE partners as there to provide the services designed without their input. So our new action plan’s three actions include co-design becoming a core expectation, with commissioners recognising that some of their scarce resources could usefully be invested in user-led and grassroots groups which are their only viable routes to the people with whom they need to co-design the future. As areas start to co-design in that way, as pioneers like Greater Manchester are already doing, they are hearing a clear demand for health and social care services which help people to live well and to remain independent and resilient in the face of long term health conditions, so our other two actions are to embed wellbeing as a shared goal for health and care services, and to enable local leaders to commission, demand and pay for wellbeing and resilience. We heard from the sector about the need for tools to be freely available to small local organisations, not just to large organisations with research and evaluation budgets. And we were excited by the promising examples of social prescribing and other approaches which, when done well, enable commissioners to work with intermediary local bodies to get their resources effectively to the full range of VCSE organisations. We argued in our original report that fund should always be on a ‘simplest by default’ basis, avoiding expensive, time-consuming and overly bureaucratic processes which are often evidence of a lack of understanding of what the VCSE can bring, rather than reflections of any real regulatory imperative.

Our action plan, which has been adopted by the Health and Wellbeing Alliance, is an attempt to bridge the statutory and voluntary worlds. That bridge will enable people to travel more freely between their lives at home in the community and the world of service support which can too often be inaccessible. One tangible way to bridge between the values of the VCSE sector and what the statutory sector will place a value on, would be to use routinely the existing Social Value Act powers, which allow commissioners to demand social value such as use of volunteers, or employment of people with lived experience, from all of their contracts. Jon Rouse says, “The Greater Manchester Health and Social Care Partnership based our working relationship with the voluntary, community and social enterprise (VCSE) sector on the recommendations from the Joint VCSE Review, which included that statutory and voluntary agencies should work together with local people to co-design better health and care services. We welcome the new VCSE action plan and expect to lead the way in using the Social Value Act powers routinely in our health and care contracting, to get the best value possible from public funds.”

Bridging between those two worlds means building from both sides, so I want to end with a challenge to my own sector. It’s not enough for us to talk about our community roots: we need to demonstrate that they are still strong and healthy. If we are to share in the power that goes with co-owning health and care systems and their resources, we must also be willing to share responsibility. The inequality of our current public services, and their outcomes, was the strongest message we heard during our consultation. As voluntary, community and social enterprise organisations we need to look hard at our practices and the way we make decisions ourselves, to be sure that we are part of the solution to that injustice.

The asset-based council

There is growing realisation that councils cannot do many of the things that we have been used to them doing. As their budgets are cut, and cut again, many council managers spend a great deal of their time deciding what they cannot do. But in an age of austerity, what do we think that councils can do? We’ve had the ‘co-operative council’. Perhaps it’s time for the asset-based council.

An asset-based council has no customers, only citizens. It has no providers, only partners. It is responsive to need, but looks always for capability and potential. It is confident in the things it can do and the difference its people’s skills and expertise can make, but it has the humility to recognise what it cannot do: fix people or communities.

An asset based council:

1. Has a living map of the area’s resources and works with the whole range of assets: state and private money, social action, community groups and charities, services, private sector and enterprise, buildings and land.
2. Sees its role as enabler and facilitator: equal partnership is the default working mode and all of its staff and those of its partners are trained in asset-based thinking.
3. Passes ‘the connection test’: challenging all service interventions to build people’s resilience and social connections and investing in models which can demonstrate this added value.
4. Uses the Social Value Act principles by default in all contracting and grant making.
5. Builds and sustains social and community enterprise as part of ensuring that it has a wide range of asset-based support models.
6. Builds mutualism and shared ownership, including through use of the Localism Act, and increases year on year the proportion of the public service workforce who have current and recent lived experience of using those services.
7. Has a community development worker (e.g. a Local Area Coordinator) for each identifiable neighbourhood and invests in connecting people through models such as Circles of Support, Shared Lives and Homeshare.
8. Aims to increase the proportion of its resources invested in prevention and early intervention year on year, whilst insisting that every service intervention is ‘future focused’.
9. Measures all forms of social action including volunteering and seeks an increase year on year, investing adequately in this rather than seeing volunteering as ‘free’.
10. Has an active and growing time bank.

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

What’s all this talk of ‘assets’ about?

One of the recommendations which received the warmest welcome from the government, during the discussions which fed into the social care White Paper which we are expecting in the coming weeks, was the idea that we have to move from a ‘deficit’ to an ‘asset’ based view of people. It’s unfortunate that those are horribly jargonistic terms which need some explanation, and which are open to misinterpretation.

‘Deficit-based’ refers to the fact that, at the moment, you may have to prove how bad things are (and often, how little money you have), before you can get a response from the social care system. There’s a reason for this: if services aren’t ‘rationed’, more people might want them and there’s not enough money in the system to pay for them. The problem is that forcing people to prove how little they can do is demeaning and can actually add to the problems a person was facing in the first place.

An ‘asset-based’ approach says that we should always look for people’s strengths, resources and potential to solve their own problems. This has to be right: my kids’ school is open to everyone their age and the teachers are focused entirely on helping the children to grow and become more independent and responsible. It’s a happy place. I feel slightly less positive about my GP surgery – it’s there for everyone, but I only go there with a problem I can’t fix and I’m in the hands of experts who know stuff I don’t understand myself. Social care is often a place of last resort. It is becoming more asset-based, in that

Setting the pace in Derby

Promote Ability Community Enterprise, known as p.a.c.e, is a community interest company set up by Debbie Jones and Craig Fletcher.  Through their 23 years of experience of front line work for the City Council and nine years working with voluntary and community organisations they felt there was a gap in services for disabled people to improve their health and quality of life choices.

From the seed of the idea, developed whilst sitting in the pub, along with donations, a helpful benefactor, support from friends, family and the community and a lot of hard work they now have a centre, with a gym, workshop and café.  They have over 20 clients per week, both self-funders or personal budget holders who buy assistance with support planning, life coaching, woodwork tuition and gym instruction from the three full time workers. Also their café is open to the public.

In the future they are eager to move towards rehabilitation services and are looking to work with local health services to develop preventative and re-enablement support. Find out more about them at: www.pacederby.co.uk

Ditch ‘prevention’!

This is the last blog in a series inspired by a seminar with social care leaders which looked at the question of citizen and community-led change.

It became clear early on in the discussion that some people had arrived expecting a debate about ‘social capital’ and community development, whilst others had been expecting a debate about early intervention and prevention. Personally, I believe that both of those concepts do, or should, mean much the same thing. Put another way, soon after I agreed to become the ‘co-lead’ on prevention and early intervention for the social care White Paper, I decided that given the choice, I’d drop the language of prevention and early intervention entirely and replace it with the language of well-being, empowerment and citizen-leadership.

Sue Bott of Disability Rights UK reacted to talk of prevention like this: “People who use services don’t want to be divided into the fixable and the not-fixable”. The problem is that prevention is all about people’s problems (will you be a drain on resources?) whereas the things ‘preventative services’ wish to achieve, are best achieved by focusing on people’s gifts, skills and assets.

‘Early intervention’ is just as bad: if the territory of ‘prevention’ is all about tackling isolation, helping people to connect and empowerment, those are outcomes which are just as relevant to the person who has just started to become less mobile in later life, the person with a life-long physical impairment or the person at the end of their life. No one wants to be lonely: whatever else is going on in your life, being lonely is miserable and worse for you than smoking.

So I think it’s time to move on from thinking about how to save money through reducing NHS admissions, which might involve coming up with wheezes which simply transfer the cost to social care, and instead think whole-person and whole-community. People will always need specialist responses and hopefully those responses will continue to become more coordinated, skilled and efficient. But the real gains will come when all services, whether they are used by people with ‘low level’ or ‘high level’ needs, think beyond meeting the present need and towards increasing the likelihood that the individual – and often their community – will be more knowledgeable, networked and confident in future.

If we can get that right, not only will more people be able to live a good life, with fewer trapped in a cycle of dependence and ‘revolving door’ use of crisis services, but savings generated will be more likely to be real, and to the public purse as a whole, not just to one sector or another.

An exclusive club no one wants to join

In my last entry, I reflected on some of the questions I was involved in debating at a seminar for senior social care colleagues who are all trying to embed ideas of community and citizen leadership into their local area. I suggested that there is no one way of achieving this, but a number of quite complex ways of contributing to it. Here’s an attempt to unpack that a little further.

We started the session by asking colleagues to think about the journey that people make in and out of the social care system. At present, that journey can feel like being presented with a succession of doors and the challenge to batter, argue or beg your way through each one, with the promise of a service at the end of it. If social care was a nightclub, it would have large bouncers, a strict door policy, a small range of rather expensive drinks and no pass outs: once you’re in, you can’t leave if you want any chance of getting back in later on. I was struck by something Lynne Elwell of Partners in Policymaking said recently: “I spent years trying to get my daughter into the system, and then as many years trying to help her escape again.”  

We can’t afford a social care system which is an exclusive and expensive club, particularly when it’s not a club many people want to be a member of. So, counter-intuitively, to reduce the costs, we need a system which is open to everyone, but which is just as easy to leave, and return to, as it is to enter. Derby have been developing a Local Area Coordination approach

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

1 in 5 of London’s User Led Organisations to close

I received an unusually high number of responses to my blog on User Led Organisations (ULOs) below. Steve at NDTi kindly shared the link to a report by Inclusion London, called A Matter of Survival, Funding experiences of London’s Deaf and disabled peoples organisations and implications for disability equality.

The findings are stark: 1 in 5 expect to close, most have been cut and most will be cut again this year. The cuts are already having an impact upon those organisations’ ability to both support the (rising number of) individuals who need them, but also on their roles as campaigning and influencing organisations. Most report that communications with their local authorities were deteriorating, with half saying the council’s plans were unclear.

This picture is a long way from the model of ULOs bringing citizen’s voices to the heart of commissioning processes. http://www.inclusionlondon.co.uk/its-a-matter-of-survival