Posts Tagged 'social care'

Shared Lives: a new health and care system


Alex Fox

Alex Fox is the author of A new health and care system – out today and launching at Nesta this evening.

Here he unpicks the dehumanising tendencies of our public services to introduce a new health care model where those living with long-term conditions can achieve wellbeing in a system that looks at people’s strengths and capabilities, and their potential, not just their needs.

“The NHS was designed in the 1940s for brief encounters: healing us or fixing us up. It often does that astonishingly well. But now 15 million of us (most of us at some point during our lives) live with long-term conditions; three million with multiple long-term conditions. We cannot be healed or fixed, we can only live well, drawing on state support relatively little, or live badly, drawing on state support heavily and falling repeatedly into crisis. That long term, increasing reliance on intensive support services is not only likely to feel miserable to us as individuals and families, it drives long term financial meltdown which will bankrupt our service economies, even if they survive the current period of austerity.

“…we remain locked into seeing people who need support as illnesses, impairments, problems, risks, not as people who can and must share at least some of the responsibility for their own wellbeing.”

So we need a different relationship between people with long term conditions, their families and the services they turn to for help. But health and care leaders continue to talk and plan as if the health and care system was fixable by streamlining what we currently do, integrating various kinds of organisation, or making better use of tech. This is because, whether we use public services, work in them, or lead them, we remain locked into seeing people who need support as illnesses, impairments, problems, risks, not as people who can and must share at least some of the responsibility for their own wellbeing. We do not recognise that people who live for years or decades can become more expert in what works for their wellbeing than many of the professionals who necessarily dip in and out of their lives. Family carers provide more care than the state, but even they are not recognised as vital members of a wider caring team, who might need knowledge, training, equipment and emergency back up just as much as their paid colleagues.

“…fit support around a good life instead of asking people to fit their lives around a good service.”

To unpick this, we need to trace the dehumanising tendencies of our public services from their first contact with people who may need their support and their families, through all of their interactions, to the ways in which they ultimately reject, or in some cases, cling on to, their inmates. With demand rising, services are putting more resources into assessment processes designed to keep away the less needy, but those processes are themselves a drain on resources, and they ensure that those who meet needs thresholds are least able to identify and build on their own capacity to self-care, and have already had their confidence and independence demeaned and undermined by bureaucracy.

The alternative is to take an ‘asset-based’ approach to every long-term support service offered: looking for people’s strengths and capabilities, and their potential, not just their needs. For nearly everyone, these ‘assets’ are partly their relationships with friends and families, so every support service must be delivered in ways which fit round and back up those informal networks, minimising disruption to them.

There is already at least one nationally scaled support model which does this: Shared Lives, now used by 14,000 people in almost every UK area.

Edward, Stephen and Christina’s story


Edward is 66 years old and lives with Shared Lives carers Stephen and Christina. Edward has a learning disability and has been blind since childhood, and when living with traditional methods of support his independence suffered. He didn’t have his own space and was restricted from carrying out many of the tasks and routines of daily life, as well as access to broader life experiences.

Stephen had had contact with Edward through his previous work as a social worker. He perceived that Edward had a lot of potential and believed he could do much more for himself. So when Stephen became a Shared Lives carer and developed his own personal care skills, he and Christina opened their home to Edward and made it their mission to develop his confidence.

The transformation has been profound, with Edward describing his increased independence: “I’ve got my own room and all the things I need. It’s been brilliant. I haven’t looked back since I’ve been with Stephen and Christine.”

Edward has gone from a situation in which he hardly ever experienced leisure activities or life outside home, to having an impressive list of holidays and trips under his belt. He has been to Las Vegas, and taken a helicopter ride over the Grand Canyon. Closer to home, with a bit of support from his Shared Lives carers, he has been to a Formula One Race at Silverstone: “I could feel the cars!” said Edward, describing the sensation of picking up the vibrations of the revving of engines through his feet.

Stephen has encouraged Edward’s enjoyment of the atmosphere at sporting events – and they go to the rugby almost every week. Through Shared Lives, Edward has been able to explore his pre-exiting interests in cars and sports to the full.

Shared Lives demonstrates that it is possible to combine people’s own capacity, with the strengths of positive family and community life, and the back-up and resources of a regulated care service. No one approach can be the magic bullet which will heal our ailing NHS, but Shared Lives offers lessons and challenges which could be taken up by any service: look for the person, not the condition; fit support around a good life instead of asking people to fit their lives around a good service; always connect.

A new health and care system [FC]A new health and care system, by Alex Fox is publishing on 28 February 2018 and is available with 20% discount on the Policy Press website. Order here for just £15.19.

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Care and caring: challenge, crisis or opportunity?


Sue Yeandle

As the first issue of the International Journal of Care and Caring publishes, Sue Yeandle, Editor-in-Chief, highlights the global space that care now occupies and introduces the journal as a new forum where world-class knowledge about care, caring and carers can be shared.

Issue 1 of the International Journal of Care and Caring is free to access on Ingenta until 30 April.

“From Nairobi to Tokyo, Sydney to Bogota, Montreal to Stockholm and Gdansk to Glasgow – and beyond – care is more visible than ever, and an issue of growing importance all over the world. It is central to human life and relations. It underpins the world’s health, employment and welfare systems. It affects every family and human being on the planet.

“In all its horror, glory and daily realities, care touches us at every level.”

Continue reading ‘Care and caring: challenge, crisis or opportunity?’

Get social care right and the NHS will benefit

How can we improve access to and quality of social care? Catherine Needham, co-author of Micro-enterprise and personalisation, discusses how micro-enterprises and micro providers could improve care services. 


Catherine Needham

At a time when the Red Cross is warning of a ‘Humanitarian Crisis’ in the NHS, there is a growing recognition that pressure on NHS services will not be alleviated unless we get social care right.

Social care services support frail older people and people with disabilities. They are run by local government and have borne the brunt of the local authority cuts in recent years, with around 26 per cent fewer people now getting help than did in the past.

Many care providers have gone bust due to downward pressures on fees and in many parts of the country it is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.

“It is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.”

Together these pressures contribute to older people being stuck in hospitals, unable to be discharged into the community because the support is not available to them.

Fixing social care

Getting social care right is not a quick fix. Access to good quality, affordable care for people with disabilities and older people is a challenging issue.

Continue reading ‘Get social care right and the NHS will benefit’

Policy & Politics: Making it personal

Personalisation is squarely at the heart of current policy debate around adult social care. For the last 10 years the British government has been experimenting with moving away from assisting users through providing services drawn from a relatively short menu of possibilities. Personalisation gives users personal or individual budgets and allowing them discretion to determine how they think the money should be best spent to meet their own understanding of their needs.

From a policymaking perspective it is a fascinating development because stakeholders from very different perspectives feel able to support it. The market liberals see it as a means of introducing competition and choice into public service provision, while those more concerned with autonomy and dignity see it as a means of empowering service users. Those concerned about the size of the welfare budget see it as a more efficient way of achieving positive outcomes for those receiving assistance. With such diverse constituencies lined up behind it, it is perhaps not surprising that the personalisation agenda has momentum.

And this is the case despite the need for several notes of caution. First, there is the tension between the individualisation of welfare and society’s collective responsibility for meeting the needs of its population. Second, there are concerns that personalisation may be great for some but it is not necessarily beneficial for all recipients of social care – older people in particular. Third, the evidence that personalisation delivers cost savings and enhanced outcomes is promising, but by no means overwhelming. Some would contest it vigorously.

Debate about personalisation can also occur at a more conceptual level. Precisely what type of state intervention does it represent? It is not the sort of direct service provision that much of social care provision has traditionally been based upon, but at the same time it isn’t a pure income transfer of the type so beloved by economists. In a paper in the current issue of Policy & Politics Simon Duffy and his colleagues offer a framework for thinking about personal budgets as a conditional resource entitlements (CRE). The characteristics of such entitlements can be examined in relation to five dimensions: autonomy, flexibility, targeting, support and conditionality. The authors argue that the nature of the conditionality associated with personal budgets differentiates it from other types of CRE: the focus is less on how resources are spent and more upon outcomes.

Perhaps the most interesting aspect of this issue is what personal budgets might tell us about future directions for welfare. Here Duffy et al offer a brief discussion of three possible scenarios. First, personal budgets are a transition in the move towards pure income transfers. Second, personal budgets represent an optimal state – they represent the best of both worlds. Third, personal budgets represent a stage in the process of shifting greater responsibility for meeting need away from the state and towards the individual. These are all plausible futures. Which one is realised will depend in part on how we make sense of the agenda and how we narrate it. Whether we embrace it uncritically or whether we contest it. There is much still to play for.

Duffy, S., Waters, J. and Glasby, J. (2010) ‘Personalisation and adult social care: future options for the reform of public services’, Policy & Politics, Volume 38, Number 4, October 2010*

Alex Marsh, Management Board, Policy & Politics

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Also available: Direct payments and personal budgets: Putting personalisation into practice by Jon Glasby and Rosemary Littlechild

Should recording in social work be given a higher priority?

With the impending cuts in the public sector that the new government will be implementing this year, people working in social care services will be understandably apprehensive about what those cuts will mean for them. One area that may be a welcome focus for attention in social care is the concern over the proliferation of paperwork and the time this takes away from the direct delivery of care. Cutting down on paperwork is an issue that most people, whether working in the social sector or not, would support. It is a means to make services more efficient. Efficiency will be even more of a priority with the pressure on budgets.

However, while the reduction in paperwork might receive considerable support, we also need to remember that concerns over poor record keeping have featured in many inquiries into tragedies involving social services for many years. While more paperwork is not necessarily the answer, more effective record keeping should be a priority. Understanding what might be involved in making records more effective is explored in Recording in social work: Not just an administrative task. In her six year study Liz O’Rourke studied the experience of social workers in over half the social services departments in England and Wales and found that recording is a highly complex task. It is also a strangely neglected issue when considering training needs. Most social workers reported that they learned to record by looking at other people’s files, and then were left confused and uncertain as to what was expected when they found inconsistency in those files. If we do not afford a higher priority to recording then we will continue to see social work records feature in each successive inquiry following yet another tragedy. We ignore recording at our peril.

What do you think? Should recording in social work be given a higher priority, or will this just increase the paperwork practitioners are expected to complete? We’d love to hear your thoughts.

Liz O’Rourke, author of Recording in social work: Not just an administrative task

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