Local Area Coordination: the new front door for care and health

Local Area Coordinators work in a small neighbourhood and have an open door for individuals and families at risk of developing greater support needs. They have the time and space to get to know people and help them identify what a good life looks like to them and how best to achieve it. LACs don’t just look at a person or family’s needs, but also at their capabilities and potential. Their goal is to help people to find practical ways of doing the things they want or need to do, developing and using supportive relationships and being part of community life. Where community connections or activities aren’t available, the LAC has a community development role, as well as helping formal services to reach those who most need them and to shape support around people’s capabilities. So where an older person who is struggling to live well and independently, has become isolated and reluctant to accept formal help, the LAC approach would be help that individual identify the things they want to change, build connections with those around them and think about the contribution they want to make to their community. One older person who was isolated, in decreasing health and struggling to maintain a safe home, turned out to have been a keen angler. The LAC didn’t look for a befriender to take him fishing, but someone who wanted to learn to fish. Making that connection and contributing to someone as their teacher, was the key to that individual taking control of many other aspects of their life and avoiding the path to hospital or residential care.

This week I chaired Capita and the LAC Network’s national LAC conference hosted by Capita Conferences. We heard strong support for LAC from NHS England, local areas including the Isle of Wight vanguard and Derby, and we heard from LAC founder Eddie Bartnik. Here are my opening remarks:

Services which aim to prevent people developing significant support needs have always wrestled with a paradox, often without realising it. The paradox is that the act of offering support can in itself reduce, rather than help build, an individual’s resilience.

Too many information and advice services are a collection of signposts into service land. Many interventions begin with assessment of need. But often, the more accurately and comprehensively we define a person’s needs, the less we can know of their capabilities, strengths and potential.

Often the very processes we use to help people stay or return to independence become the funnels into our service pipelines. Continue reading

Local Area Coordination – a different starting point

At the Local Area Coordination Day in Derby, people from social care organisations like us and around a dozen councils heard from Eddie Bartnik, mental health commissioner from Western Australia (WA), who took time out from his holiday to give a personal perspective on how he helped to develop Local Area Coordination as the basis of reforming the entire WA care, support and inclusion system in the late ‘80s. That reform rejected the starting point of “What services do you need?” and started with “What would you consider a good life?” The principles were: personal, local and accountable (which sounds encouragingly close to the ethos of our own, Think Local, Act Personal). 

The different attitude of a Local Area Coordinator was summed up by the work of an LAC who came across a number of isolated and stressed Mums of disabled children. The traditional response would be counselling, advice and respite. The LAC response was to bring those parents together: the formed a group they called Recharge. The LAC helped them to find an accessible leisure centre and negotiated with the centre that it would make its activities accessible to their children, whilst the parents took fitness classes and socialised. The cost was low and the benefits multiple: not just to the parents who were able to offload, get some exercise and have some fun; to the children who were now included in new activities, but also the staff and the centre which learned how to become accessible. A key lesson was to base LACs outside of state agencies, but with a link into the state system – and easy access to small amounts of money – when they need it. As one UK LAC at the event put it, we won’t take referrals, with the implications of a transfer of power associated with that, but anyone can introduce us to people.

One project in WA looked at how to help people with a significant impairment to live in an ordinary home. They have developed a community living placemat which sets out the building blocks including support, info, planning, supportive family and friends, building opportunities to explore and work towards goals, developing partnerships. Using this tool, they moved away from a choice between “you do it all” or “we’ll do it all” and instead helped people to bring their own resources – which sometimes included money and housing which people had long wanted to use but couldn’t get support to – into play in a coordinated way, such as developing shared living approaches.

Eddie outlined some rules for reform. In no particular order, these are the ones I picked up, paraphrased in some cases:

  • Ask, what kinds of relationships would you aim for if you started ‘social care’ again? We wouldn’t start from here.
  • Getting to know whole person well over time creates the possibility of speedier change later on. Move too quickly early on and all you will have is false starts.
  • You won’t understand and meet people’s needs, if their needs are all you are interested in.
  • We all use our natural networks to help us find jobs, social activities and other opportunities which we use to make a life. Services are a poor replacement for these networks for isolated people, particularly when that isolation is caused or exacerbated by a building-based service.
  • ‘Contribution’ is the most neglected concept in public services. Well being comes from what we are able to contribute. Start with high expectations.
  • People have ‘natural authority’ – respect it. Continue reading

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 Continue reading

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