How many social care workers does it take to change a lightbulb?

I spoke at GovToday’s Social Care conference yesterday on ‘rethinking personalisation.’ My argument you won’t be surprised to hear was not that we should re-think whether personalisation is a good idea, but that we still have more to do in really understanding what good care and support as part of living a good life really looks like. I started by suggesting that when I talk to policy makers and when I talk to people who use services and front line workers it can seem like there are two different worlds. In one world, anything is possible. We can make savings whilst tailoring support to what people want and helping people find good lives. The other world feels at times like it’s full of cuts, gaps, unmet need and failures in even basic care and safety. You could say that just shows how out of touch with reality the people dreaming of personalisation are, but you can find real people living real lives in both worlds.

I believe that a lot of the people living in the world full of possibility and who have found many of the resources they need, get to live in that better world not because they live in an area where there is endless public money (not sure where that would be these days), but because they have found other kinds of resources, including being supported to find and build their own resourcefulness. Often when people are able to live lives which feel whole and not fractured, another pair of very different realms – the realm of services and the realm of families and friendships – have found a way of complementing each other, rather than ignoring or fighting against each other.

The Joint Committee which looked at the draft Care and Support Bill reports next Tuesday. I’m hopeful that it will recommend that the Bill does more to create that alignment between paid and unpaid, formal and informal. If it does, I think that the Bill and last year’s White Paper could be seen in future years as a turning point for social care, and perhaps for attitudes to public services more generally. This won’t be about cutting existing services and hoping for the best. But it will be about a system which Continue reading

Have we become a neglectful society?

Norman Lamb, the Care Minister, gave an interesting interview in the Telegraph over the Christmas period, which was given the rather unfortunate headline, “Neglectful Britons blamed for forcing elderly into care homes”. This picked up on the Minister’s view that we have become a “neglectful society” and that we need to rebuild “neighbourly resilience”, without which, he was quoted as saying, pensioners lead dismal, lonely lives.

Mr Lamb was given a hard time for this by Sarah Ditum, writing in the Guardian, who said that “The government has some cheek to say we’re not caring enough” and pointed out that more unpaid family carers are caring for more hours per week than ever; a huge contribution which Ditum argues the coalition is undermining with cuts to public services.

Ditum is right that, as social care services are being ever more tightly rationed, whilst the impact upon the NHS is starting to show, the impact upon family carers is often hidden, yet very real.

However, I don’t read the Minister’s comments as being about unpaid family caring. His suggestion that we have become a “neglectful society” is strikingly reminiscent of John McKnight’s suggestion, that we (in his case, the ‘we’ being US citizens in the 1990s) have become “a careless society”, in his book of the same name. McKnight was one of the founders of ‘Asset Based Community Development’, an idea which Lamb’s predecessor, Paul Burstow, talked about approvingly in the run-up to launching the social care White Paper. ‘Asset-based’ or ‘strength-based’ approaches start with the premise that seeing only people’s needs and vulnerabilities (their ‘deficits’) will lead to services being designed to impose outside ‘expertise’ at the expense of individual, family and community resilience. In other words, poorly designed, if well-intentioned, social services can become part of the problem, ‘colonising’ communities and ordinary human relationships and leaving citizens who have, in McKnight’s words, “grown doubtful of their common capacity to care”.

So McKnight was not arguing that people had stopped caring about each other, but that they had stopped seeing the active support of those around them as their role, instead believing that only the state was qualified to provide support. It’s a powerful – and by virtue of its power, a dangerous –  argument, but one which needs serious consideration.

A small-state fanatic could see it as an excuse to cut services in the naïve belief that people will start supporting each other as soon as the state ‘gets out of the way’. McKnight was instead arguing for services which were more led by people and which worked alongside and supported their relationships, rather than supplanting them. You only have to look at the isolation of thousands of older people or the disempowerment of many people with learning disabilities living in ‘service settings’, to realise that even well-funded traditional services cannot address isolation, in all its many forms.

I met Mr Lamb a number of times in the Autumn, including to discuss asset Continue reading

A better front door for social care

This week we’re really pleased to be publishing, with some of our closest allies, a paper which sets out how the government could make a better ‘front end’ for social care. In other words, what happens when someone first encounters the social care system. It uses real people’s experiences of assessments and discussion about eligibility for services to ask what those processes do to a person’s independence and to their relationships with their family and community. At the moment, whilst most of use the NHS fairly regularly, and our local GP is often a familiar and friendly face for the NHS, our first experience of social care is usually in a crisis, and can be first and foremost about how much money we have (Are you poor enough to be our problem?) and about our needs, rather than our choices and the resources and relationships we might be able to draw on (Are you needy and vulnerable enough to be our problem?).

The imminent (early July now??!) White Paper is an opportunity to create a system which feels more like a partnership, and less like a battle.

The partners in the paper include ourselves, our sister organisation Community Catalysts, In Control, Inclusive Neighbourhoods and Partners in Policymaking. We’d all be interested in your reaction to these ideas – if the government is really going to create a friendlier, more cooperative and collaborative social care system out of the funding-squeezed battleground many experience, they are going to need all the ideas and help they can get.

See “Redesigning the front end of social care” here: http://www.sharedlivesplus.org.uk/en/publications-resources/free-publications/policy-research-campaigns/

Local Area Coordination

How can we kick start radical change in a care and support system which is suddenly starved of money? Perhaps an equally valid question is, “How can we not?” This second question can only be asked if we genuinely believe that there are ways for communities to face their challenges which aren’t entirely reliant upon services.

Local Area Coordination (LAC) is now at the core of care and support in Australia, after twenty years of development and numerous evaluations. Ralph Broad, who has worked in Australia and the UK remarks upon the fact that outcomes in Western Australia are better than those in the UK, despite the fact that even a recession-hit UK is still better resourced than Western Australia has ever been. LAC is a way of recognising that people are not passive “clients”, “service users” or “customers” of a social care system. It puts professionals in new roles: working alongside people. Local Area Coordinators in each small locality have an open door, access to information and small amounts of funding, but most importantly a remit to nurture local solutions and keep people strong. They help people to access services where they are the only option, but they see services as the last thing to consider, not the first.

LAC is not an initiative to ‘drop in to’ the existing system, with its preoccupation with gatekeeping services for those deemed needy and vulnerable enough to qualify. It is best used as a way to transform the whole system, starting with Continue reading

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 Continue reading

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

User-led organisations: endangered species?

I do my best to remain optimistic during these too-frequently grim times. One of the determining factors of what the sector achieves on much diminished resources, will be what we continued to believe was possible. Our public finances perhaps haven’t been this bad since about 1948. But in that year our grandparents looked around at the post-war wreckage and decided that a National Health Service was possible.

Of course, those were the days of when big national infrastructures were created from Whitehall (casual observers may be surprised to hear that the current NHS Bill, with its thousand amendments, is an example of ‘bottom up’ change). Social care has been re-shaped to give more control at the level of the council, the community and the individual.

So User-Led Organisations (ULOs) should be a key part of ‘personalising’ social care. After all, they embody the idea of individuals who use services being in control, and their work is often about people having a voice in local decisions, or being able to shape their own care package. They are also typically small and local, forming a bridge between councils and the people who are most affected by their decisions.

So I couldn’t help my heart sinking when, on the same day, I heard about two areas which were planning sweeping cuts to their ULOs. Had those areas completely misunderstood the basics of personalisation? Apparently not: at least one was an area with leaders who are advocates of personalisation. So what was going on?

It’s always risky to comment on local changes from a distance, but my impression is Continue reading

Three questions

The closure of day centres  – and other ‘building-based’ services – continues apace. I subscribe to a popular email group run by the Foundation for People with Learning Disabilities (http://www.choiceforum.org) and there has been a spate of messages recently from family carers and professionals raising concerns about this. There’s even a report of an area opening up a new day centre for people with complex needs, having closed the old one and decided that alternatives weren’t working.

The debate about day centres quickly becomes ideological and couched in black and white terms. One side believes that the alternative to day centres is casting people with learning disabilities out into a solitary existence in a ‘community’ that turns out to be at best elusive, and at worst, openly hostile. The other side believes that day centres are evidence that segregation and institutionalisation are far from the memories they should be.

I’m reminded of the anecdote a former colleague told me of a visit by an ageing member of the House of Lords to the day centre for older people my colleague was running. It became clear that Lord X might himself be in the early stages of dementia and also that he was having a very enjoyable time, chatting with people his own age. My colleague said to Lady X, as she was thanking him for his hospitality, that his Lordship would be welcome to drop in and use the facilities whenever he wished. “That’s awfully kind of you, but my husband is already a member of the most exclusive day centre in the world”.

Most of us belong, or would like to belong, to clubs and groups of one kind or another. The difference being, that most people have choices about what to belong to and to opt out of. Clubs and groups which want us as – usually paying  – members, have to design themselves around our changing wishes and needs. We often get to contribute as well as to recieve something. And we get the option of spending time on our own as well, when we wish.

I believe that the painful and often angry debates about building-based services could nearly always be avoided if, instead of asking “Should this day centre close?”, decision-makers always asked everyone concerned these three questions: Continue reading

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 19th, 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 Continue reading