Own it

I enjoyed meeting colleagues from Hertfordshire at the council’s annual Festival of Practice: a week of seminars, learning and reflection which the council invests in its social care team and their colleagues in the council, NHS and the voluntary and community sector.

During my session on Escaping the Invisible Asylum we talked about the difficulty of introducing asset-based or strengths-based practice into stressed, medicalised systems, if we want those new approaches to take root and grow. However small the beginnings, the goal must be complete transformation of the local system, so that every intervention in people’s lives is asset-based. Key tests for this are that all services and interventions:

1. Look for what people can or could do, not just what they can’t
2. Connect people and minimise the extent to which they disconnect people – our close relationships are key assets
3. Build resilience for the future, rather than just addressing ‘presenting need’.

Only services and systems which are co-designed with the people who use them and work at the front line will achieve these changes, so these are shifts in who has power and responsibility. For instance, if your service is genuinely asset-based, its systems will treat the risks that people take as theirs to own, but will share ownership of the risks the organisation carries or creates: the individual remains in control wherever they can exercise that control, even when things get risky for them or the organisation working with them. The older person who falls regularly but wants to live at home has that right. Great hospital discharge teams support that person to understand and mitigate that risk, rather than pushing them into a living situation which feels ‘safer’ to the professionals.

We discussed the behaviour changes that would be needed if a system was to become genuinely asset-based, and the systems needed to make those behaviours possible, such as offering help to people to plan for a good life, rather than always starting with a needs assessment. The table below suggests some behaviour changes at the front line, and the leadership behaviours needed to make those changes possible and safe:

Workers and volunteers	Commissioners and leaders
Seeing capacity & potential as well as need	Building in more time: offer planning before assessment?
Humility and courage	Healthy workplaces.
Confidence: focused on what matters most to people	Seeing risk more clearly Measure good (& bad) outcomes
Valuing relationships, networks	Thinking ‘whole-household’
Sharing responsibility: ask more, offer more	Sharing resources, knowledge, power

The most important question, then, is what changes would these new approaches ask of people who use services and their families? And what would they be offered?

Too often, a move towards community-based approaches is framed as asking for more volunteers, or asking more of families who already have unsustainable caring burdens. It is much rarer for those currently in charge of resources and systems to offer to share that power and the responsibility which goes with it. At the heart of that reluctance is a lack of trust, and asset-based thinking starts with trust: faith in people’s ability to take responsibility, in their creativity and that they won’t act purely in their own interests. This is why coproduction is so important: any asset-based system has to be co-designed with the people who will use it, deliver it, share responsibility for it and ultimately own it.

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.