Alex Fox Big challenges, micro-scale solutions 291112

www.Shared Lives Plus.org.uk

www.communitycatalysts.co.uk

Big challenges, micro-scale solutions

Alex Fox, CEO

Shared Lives Plus

www.SharedLivesPlus.org.uk

http://alexfoxblog.wordpress.com

Chair, Care Provider Alliance

Karl and Clare with carers Blossom and Mike, at

their wedding, before moving to live independently



Some UK History

1948, Bevan creates the National Health Service

in a time of great austerity. The NHS is designed

to treat illness for free.

Non-medical care for older people is largely

provided by families, particularly by women. Most

people die after short retirements.

People with mental health problems and

disabilities are usually placed in large hospitals,

sometimes for the whole of their lives.



Some UK History

Average life was 66 (M), 71 (F) in 1948. Now 77 & 82.

But healthy life expectancy is only 63.5 (M) & 65.7 (F).

Dementia grows, as does isolation for older people.

Women join the workforce. Families live more distantly

from each other.

Social care develops separately from the NHS. Social

care is organised by elected local councils.

NHS organised nationally, then by local unelected

committees, now to be led by family doctors.



Social care changes

A sector characterised in the 1970s and 1980s by:

• disabled people warehoused in long-stay institutions;

• a medical model of disability and low expectations of people;

• „one size fits all‟ state social care services, centrally planned

and organised, with little individual or family control.

But also:

• community and whole-family social work approaches

• huge contribution from unpaid family carers (was and

remains poorly recognised and valued by the state.)

• communities which were more stable and cohesive?



Community care reforms

The Griffiths Report (1988) and others led to:

• closure of nearly all long-stay institutions for people with

disabilities

• huge shift of care for people with disabilities & mental health

problems, into community-based settings

• „person-centred care‟ develops, then „Self-Directed Support‟

and Direct Payments (the cash instead of the service).

But:

• model remained individual (not family / community) focused

• needs, not asset-based

• led by professionals and decision makers, not people



Personalisation in social

care

Personalisation was adopted by government in „Putting People

First‟ in 2007. It had four equal parts:

1. advice and information for everyone;

2. developing supportive communities („social capital‟);

3. prevention;

4. introducing choice and control: personal budgets.

Only Number 4 has happened on a large scale.



Some things are better…

These reforms have changed UK social care for the better:

• Very few long term, institutions for disabled people

• Principles of choice, control and independence for all people

who use services are fairly well-accepted

• The rise of user-led or user-owned organisations and

involvement of people in decision-making

• Most people who use services and family carers are

satisfied with the services they receive

• 340,000 personal budget holders (25% using Direct

Payments, many to employ a Personal Assistant) (ADASS 2011).

• Small but growing numbers of truly new approaches




Compare social care‟s progress with the NHS:

Social care

Care at home is preferred

option, few institutions.

Direct Payments, personal

budgets, user-led agencies.

Healthy charity/ social

enterprise sector.

Recognition of family carers.

NHS

The power & money is tied up in

large hospitals.

Clinicians commission; patients

are „customers‟.

State provision or private sector.

Families often ignored.



For example, thousands of micro-enterprises:

• Local people working with and for other local people.

• Some are led or owned by service users or families.

• Some would be impossible without the outcome focus of

personal budgets & Direct Payments.




…but some things have

stayed the same

• Personalisation is not always evident in practice.

• Prevention is poorly understood and often first to be cut.

• Services are rationed. Some areas are „crisis only‟.

• Services are improving, but can‟t tackle problems like

isolation – and may make them worse.

• A Direct Payment can raise your status from „recipient‟ to

„customer‟, but that doesn‟t make you a „commissioner‟.

• „The community‟ remains elusive. Isolation epidemic.

• Older people‟s support lags behind: still reliant on care

homes and older people seen as a problem, not an asset.



Direct Payments and personal budgets were radical, so why

didn‟t everything change?

• A consumerist focus on individuals at expense of

relationships?

• A focus on support needs at expense of responsibilities?

• Power structures remained – and assimilated the disruption.

• We didn‟t change culture towards valuing disabled and older

people.

• We only try to support people once we‟ve fitted them into the

social care system, through eligibility criteria.

Why didn‟t it all change?



We are starting to explore asset-based approaches:

• Look for people‟s gifts, skills and resources first, rather

than their needs, vulnerability, diagnosis.

• Refuse assumptions about people‟s potential to contribute

to own life and to those around them.

• People and communities as experts in their own lives: „co-

production‟ rather than consultation.

• Being connected to family & community is crucial.

• Asset-mapping approaches can be taken at personal and

strategic level.

• A new take on prevention: empowering and connecting.

An „asset-based‟ alternative



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£ M

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ns

Adults Social Care Children's Services Net budget

Barnet „graph of doom‟



• Focus on building supply as well as „liberating‟

demand.

• Councils have a role in building a truly diverse

market of providers, including the hyper-local.

• „Scale out‟ not just „scale up‟.

Ways forward:

new kinds of provider



• People don‟t just want to be consulted on someone

else‟s service – they may want (shared) ownership.

• Co-op and mutually owned models of service

delivery.

• Service users, families and citizens can have more

say in commissioning: e.g. participatory budgeting.

• e.g. Leeds Council „neighbourhood network‟ model.

Ways forward:

citizen-led commissioning



The biggest contributions to care, support and

inclusion are by citizens, families, communities, so:

• We need approaches which work alongside &

support relationships, rather than trying to replace

them.

• Some interventions mix paid and unpaid care,

drawing on close relationships.

• Rejecting the „gift model‟: everyone contributes.

• A networked model of care.

Ways forward:

look beyond services



• Sharing home and family life.

• The carer‟s house feels like a family home.

• Home and family life is shared, through living

together or regular visits to the Shared Lives carer.

• Organised by 152 registered schemes who recruit,

train, support & monitor Shared Lives carers.

• e.g. Alison and Mark run a pub. Neil spent a lot of

time drinking....

Shared Lives



Independence means…

Paul, 50, has recently moved in with registered Shared Lives

carer, Sheila and her family. Sheila helped Paul to get a bus

pass, to learn to use public transport and to cross roads safely,

so that he can make use of the community for the first time in

his life. He bought his first bicycle and enjoys long bike rides

with Sheila and her husband, who have helped Paul become a

visible and popular member of the community. He knows local

shopkeepers, library staff and even bus-drivers by name.

Sheila encourages everyone to „look out for Paul‟. Paul doesn't

have a lot of speech, but when asked if he understands what

'independent' means, he smiles and says 'walk'.

from the Care and Support White Paper, July 2012



• Participants are matched into real relationships.

• The matching process is the key to the relationship.

• Matching can take time, but pays dividends in

exceptionally stable relationships and added value.

“There‟s a huge gap between what carers receive as

payment and what the individual receives.”

“The whole village is helping – but in a natural way.”

• Shared Lives average individual saving = £13k p.a.

• Potential England-wide saving of £155m.

The matching process



We are developing Shared Lives for:

• young people leaving children‟s homes

• more people with mental health

problems, including those in the acute phase

• offenders and ex-offenders

• people at risk of homelessness

• parents with learning disabilities and their children

• women with learning disabilities fleeing violence

• home-from-hospital rehabilitation care

Shared Lives: the future



Networked model of care



Finding abundant

resources in a recession

• Public money is scarce.

• Informal support can be abundant.

• Move services out of purpose-built buildings into

ordinary family homes and community resources.

• Community is not a place, it‟s a set of relationships.

• Community relationships are built from close

relationships.

• The state may not need to step back, but perhaps

to step sideways.



Alex Fox, CEO, Shared Lives Plus,

[email protected]

www.SharedLivesPlus.org.uk

http://alexfoxblog.wordpress.com

Twitter: @alexsharedlives

Personalisation: lessons from social care, RSA: http://goo.gl/QSlDg.

Redesigning the front end of social care: http://goo.gl/dcxzh.

Working locally: micro-enterprises and building community assets, for

NHS Confederation's Uneasy Consensus series: http://goo.gl/YO81j.

Contact details

Alex Fox Big challenges, micro-scale solutions 291112

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