The majority of commissioning for Adult Health and Social Care is still focused on fixed and outdated service models which are determined and designed by profit-making service providers; squeezing individual and often complex needs into a broken system which is no longer fit for purpose. The result is that people experiencing a complex range of challenges in their lives often fall into a cycle of crisis, knee-jerk commissioning responses, placement breakdown, trauma and further crisis. Is the person being supported in the system complex? Or does the current system propagate complexities?
These linear commissioning processes are still the norm. Yet we all know the world of Health and Social Care changes quickly. Let’s say goodbye to traditional commissioning processes and embrace a more flexible and individualised approach. It’s called Self Directed Support.
Traditional commissioning for Adult Social Care and Health started at a time when the world of Health and Social Care was more stable and financially predictable than today. It made sense to those holding the budgets to have a model which used universal needs analysis of geographic areas (‘misery maps’) as a starting point, and then went to the Provider market place to seek solutions for meeting those needs. Provider organisations jumped to attention. Commissioning budgets quickly got tied up in framework and block contract arrangements agreed via European tendering processes and costly procurement systems which were designated by service label, and need. Lots of ‘specialist’ provider services sprung up- ranging from small Learning Disability homes to private Mental Health ‘Assessment and Treatment’ facilities and blocks of flats for people with Dementia. Lots of little ‘Care Ghettos’ were created around the UK.
There was profit to be made. It attracted the Venture Capitalists. Their cost and volume discounts stifled the small locally-based, community provider organisations, charities and social good organisations (who existed to help people to live well, learn to self-advocate and uphold their rights, enjoy citizenship in their local communities and experience a good life). The Health and Social Care market became a place for the giant corporates. The individual receiving support was forgotten- buried under the swathes of corporate governance, regulation and cost efficiency measures.
Because of this system the very need for Self-Advocacy exists, and we see an ongoing advance of legal challenges such as Judicial Reviews for people within the system who are fighting for their rights.
But this model of commissioning and market-shaping is outdated and provides a perfect breeding ground for the deprivation and abuse of human rights of the very people it should be there to protect and serve. Ultimately, it is costly, damaging and just plain wrong.
Instead of a narrow linear path to services, support by hours and tasks; we argue for flexible budgets—based on genuine person-centred and strengths-based assessment. Rooted in the intrinsic motivation and aspirations of the person and reflecting the need for flexibility which comes with the very natural and human process of changing & evolving interests, changing needs and ageing; and we argue to support the development of community connections and cohesion. Effectively the same level of connection, choice, control and flexibility which other citizens are able to access and enjoy when they are not reliant on statutory funding and provision to lead a normal life.
We argue for a recognition that Support Plans which are designed primarily around the person’s strengths, passions and motivations; rather than need, deficits and risks are more likely to achieve outcomes long-term, keep the person safe and ultimately reduce their dependency on the public purse or the repeated cycles of crisis which result in the need for high-cost emergency interventions.
We argue for more flexibility and less standardisation. For more variety and opportunity to use budgets more flexibly in order to build good personalised support which is tailored to the individual, and fewer blue-printed service models from large provider organisations. (Who wants to live in a care ghetto??) We argue for people to hold and control their own budgets, with good support to manage them if needed. We argue for ordinary homes in ordinary neighbourhoods. Good support. More courage, kindness and respect for human rights. More value for people as citizens and fellow humans. More focus on the strength and opportunity of connected communities, neighbourhoods and localities as the starting place for finding solutions. We argue for local democracy and decision-making power for communities to develop and build what makes sense for them on a local level, rather than what is determined by decision-makers who live far away, hold the purse strings and don’t have any understanding or experience of what it is like to live in those communities.
We’re thinking of the brave ones out there who challenge the current system and embrace new ways of working and stewarding the public purse. We’re thinking about a world where everyone matters and everyone has a voice.
(Based on an image concept by @waitbutwhy)
It’s called Self Directed Support. It’s actually been around for years. It’s embedded within current Health and Social Care legislation. It’s a right in law (Care Act 2014) for people to have it. Self Directed Support is where the person entitled to receive support is given clear information about their options, and a choice to use the financial resource allocated for their support (by their Local Authority and/or CCG) in a flexible way which makes most sense for them. Effectively, the person can design their own support plan. So why is it not the obvious first option?
It’s because we are still stuck with the old traditional systems for commissioning and contracting for support. We have very expensive Local Authority & Health departments and systems which are inefficient and not fit for purpose. We spend a lot of time and money on trouble-shooting poor commissioning and support arrangements which have not met people’s needs and have triggered the cycle of crisis. We have a pool of social workers entrenched in a focus on crisis intervention and budget cuts. There is no room for proactive or preventative approaches. Everybody is fire-fighting.
Let’s stop trying to re-invent a buckled wheel, calling it by a different name and expecting it to change things. Let’s be radically different.
Where are the some of the good solutions happening already?
Self Directed Support makes absolute sense- it connects naturally to all of these Strengths-based approaches. Let’s learn how to make life work well for everyone.
For more information about Self Directed Support, visit our website: www.imagineer.org.uk
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Meet Angie….she’s been an Occupational Therapist (OT) for 30 years, working in NHS and (more recently), independent OT roles to support people with developing and maintaining their independence and well-being.
Angie Carter is a registered Occupational Therapist; and also an Accredited Support Broker with the Support Brokerage Network
The introduction of Personalisation within the Health and Social Care sector made absolute sense for Angie and resonated with her value base and skill set as an Occupational Therapist.
Angie began to explore ways of helping people to take control of their own lives within her work as an OT; and her exploration led her to reading about the concept of Independent Support Brokerage. She began to recognise that her formal OT approach fitted more with the ‘Professional Gift model’, than the ‘Citizenship model’ (which was the approach followed within Independent Support Brokerage). Angie completed her training with Imagineer as an Independent Support Broker, and she joined the Support Brokerage Network (formerly known as National Brokerage Network), which is a community of practice for Independent Support Brokers and organisations who implement the values and approaches of Independent Support Brokerage within their work.
Angie is now part of the Support Brokerage Network, and has written a detailed article about her own individual journey in becoming a Support Broker; in particular- the story of one young man whom she has worked alongside to Self Direct his own support. Angie now uses her professional skill set as an OT combined with the skills and approaches of Independent Support Brokerage to offer personalised, bespoke and enabling solutions and ideas for people to lead their lives in a way that truly makes sense for them:
You can read Angie’s full article here.
You can view Angie’s Support Broker profile here.
You can read more about Support Brokerage here.
If you’re interested in the work of Imagineer; and would like more information about what we do and how to get involved, you can sign up for our mailing list & monthly newsletter here.
Here, Sarah shares some of her story about caring for her young adult daughter who is diagnosed with Autism Spectrum Disorder.
I care for my daughter who is now 20 , she needs help with daily social/ living skills. She has Autism Spectrum Disorder (late diagnosis 3 years ago), and has had a huge mental health crisis during the Covid-19 pandemic which resulted in her having to be hospitalised. She has had the most horrendous year and has been traumatised because of it (as have we her family) .
As a result, she now needs help on a daily basis. Her daily needs include: Daily living & independence skills, needing to be heard in a trusted relationship, feeling safe enough to show her need and managing new and different situations (which is very hard for her). She is building trust in her PAs and has other key supports in her church, family and a small number of trusted professionals.
She is an amazing, funny, intelligent person who is working very hard to understand herself and manage life. I am very proud of her journey.
Currently, we are provided 25 hrs of care per week (2-1) and apart from times when she is in appointments, I am her sole carer and am available 24/7 the rest of the time. Sometimes she needs me in the night as she still gets recurring dreams of her time this past year when she stayed in a mental health hospital avoidance unit. Now at home, we can only have care at the times when the agency are able to provide staffing- not always at times when we need it.
Currently, even though we have scheduled care in the family home, I often still need to be available for crisis support.
When it’s a good day, I love to meet friends, go out for meals, do craft etc.
I would love to see family and friends that live at a distance. I love to go to church and volunteer to do activities.
When things open up more theatre is great to visit.
As a carer I have had to tackle a wide variety of issues by personal research and enquiry. It has felt that on each occasion I have had to gain skills in unfamiliar areas when there should be information available.
For example : education (EHC) tribunal, legal action, safeguarding, mental health, social care, etc.
It would be helpful if there was a source for all these challenges in one place so you don’t feel like you’re alone and reinventing the wheel each time. Peer to peer advice would also be helpful.
Professional help seems there for the client but the carer may be traumatised, in need of support eg counselling etc , and are expected to continue until breakdown. Carer hubs seem to deal with a limited range of basic support. Independent support for carers in the form of a budget for counselling/ advice, etc would help prevent breakdown of care in the home.
At Imagineer, we work alongside unpaid family carers in many different ways; but one of the key ways that we can assist is by providing Support Brokerage.
If you are interested in receiving assistance from one of our Support Brokers, please contact us: info@imagineer.org.uk to request a call-back for an informal discussion, or a referral form.
For more information about Carers Week 2021, visit: Carersweek.org
The word ‘community’ can mean different things to different people. We can talk about community as a group of people with a shared interest or set of beliefs such as a sports club or a faith community. We can describe community as a geographic area in which people live, work and socialise. We can also use the word ‘community’ to describe a people group with a common ethnic or diversity label, a common ideology or political leaning.
For the purposes of this blog, we’re going to think of ‘community’ in three different layers:
Geographic communities (or neighbourhoods) are made up of a series of ‘bumping spaces’ where people congregate regularly on certain days or times of the week; and for certain events or activities. Bumping Spaces are unique to each individual community and are often the beating heart of where relational connections take place. These may be formal spaces such as community centres, libraries or GP surgeries. They may be hospitality-based spaces such as cafes, coffee shops or pubs, or they may be informal bumping spaces which take place around a particular community activity. Have you ever taken a moment to consider where the primary ‘bumping spaces’ are in your own neighbourhood? Sometimes it is surprising to discover where people congregate and where those relational connections are occurring. For example- if you ever walk past a primary school at the beginning or the end of the school day, you are likely to see a group of parents congregating- chatting, sharing stories, laughing together, commiserating each other over a poor nights sleep, and taking their children to the park to play together after school. If you ever walk in a park or countryside area, you are likely to pass many dog-walkers who stop and chat to each other, whilst their dogs play together. If you walk down a nearby canal towpath or riverbank you are likely to see barge-dwellers, boat owners and local fishermen who pass the time of day together. Community develops where natural connections occur.
In the practice of Independent Support Brokerage we often have conversations with people who are isolated and may have only paid workers and professionals in their lives. They don’t often use the phrase ‘My community’ because they don’t recognise or feel a sense of belonging to a particular community. One of the key ingredients in developing independence, resilience and wellbeing is community. Whilst we can’t prescribe community for people as such; we can provide assistance and ‘scaffolding’ to enable people to begin to develop their own natural connections and relationships- based on accessibility, interest, availability and encouragement. Often, people are held back from developing these connections, because they hold limiting beliefs about what is possible, whether they will be able to access anything, whether anybody will be interested in getting to know them, and how much things might cost.
The functions of Support Brokerage open up the conversation with the person by first understanding the essence of them- what makes them tick, what they’re passionate about, what’s important to them. What really brings them to life, what makes them smile and what they’re really good at. These early ‘discovery’ conversations provide the seeds for discovering opportunities (often at the ‘neighbourhood’ level)- for thinking about what might be possible and how we might go about achieving it. That’s the starting point for helping people to connect to their community.
The fuel for driving these types of conversations is resourcefulness.
People who access social care or health funding for their care & support needs are often restricted to a blinkered ‘service’ based view of what is possible. Often their understanding of a good life and good support is limited to a narrow understanding of ‘time and task’ based support- such as domiciliary care visits for Personal Care or meal preparation; or perhaps attending a designated day service or activity group for people with a similar diagnosis or disability. The Care Act actually intended the conversation to move away from traditional service-based solutions, and to actually start with the person and their ‘assets’ (their home, their relationship connections, their skills and other resources available to the person- in other words, the things which are ‘strong’ and available in a person’s life); in order to develop a plan which really supports the person to have a good life, and promotes and upholds their wellbeing- helping them to be really integrated into their local community and part of the diverse group of citizens who reside there. Most of the solutions to having a ‘good life’ reside within Communities in the first place.
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space.
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC
Both Liz and Sarah are practitioners, trainers and coaches in Independent Support Brokerage and consultancy for Strengths-Based Approaches with collectively over 40 years of experience in the Health and Social care and community sectors.
Imagineer Development UK CIC is a social enterprise based in the North of England with a national reach; originally set up as a test bed for Independent Support Brokerage in the UK. Imagineer is the hosting organisation for the National Brokerage Network, which is a community of practice for Independent Support Brokers. Imagineer provides a range of training & consultancy services in Support Brokerage, Person-Centred and Strengths-Based Approaches.
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In the practice of Independent Support Brokerage we often have conversations with people who are accessing social care support for the first time and discover that they don’t have any awareness of their rights under the Care Act.
This can make the whole process of navigating a social care assessment very tricky. How do you know what to say if you don’t know what your rights are?
The emphasis of the Care Act is on well-being and the ‘well-being principles’. It is supposed to be a ‘whole life’ or ‘holistic’ process, but often the social care practitioner carrying out the Care Act assessment focuses solely on the narrow view of individual ‘outcomes’ rather than the overarching well-being principles; meaning that they may not focus on the correct areas of life where the person needs most support.
It can often mean that the focus is taken completely away from the factors of a person’s life which determine their well-being, and therefore resources or services provided by Adult Social Care to meet that perceived need are just not a good fit for the individual.
It’s a little bit like talking to a mechanic about the problem with your car, then at the end of the conversation finding out that the mechanic knows all about motorbikes but not much about cars at all.
So let’s look at the well-being principles first:
These are the principles (enshrined within law) which are recognised as the determinants of well-being, in relation to Social Care eligibility.
When a person requests (or is offered) a Care Act assessment, their eligibility for support is determined by the following criteria:
The ‘outcomes’ specified under the Care Act are:
Anybody can ask for a Care Act assessment, and they should not be told that they are not eligible for support under the Care Act unless an assessment has taken place. In some areas of the UK we have seen ‘screening’ assessments being used by some Local Authorities as a way of filtering people out for assessment, but this is not within the guidance (or the spirit) of the Care Act. We have also heard from people we have worked alongside, where they have had a telephone conversation with a social care practitioner (such as a social worker) without any awareness that an assessment was being carried out, and have later discovered that their assessment took place over the phone. Most people would be unaware that they can challenge this.
There is little information shared within the public domain, and in accessible language- which explains people’s rights simply and helps them to navigate the assessment and support planning process. For example- most people would be unaware of their right to lead on conducting their own assessment (should they wish to) and to gather and share the information which goes into the assessment themselves. Could this be due to suspicion from Local Authority officers that people may abuse the system or manipulate information in order to secure support? Or is it due to Social Care departments being so stretched that they are being forced to adjust their practices around assessment and support planning to ensure minimal admin burden and lower uptake of resources?
Again- many people are not aware that they have a right to request a copy of their completed Care Act assessment and to request amendments to any of the information that is inaccurate (or missing) from it. There is often a delayed response when such a request is made; or when the assessment is shared with the person it is clear that there has been poor evidence capture and complete lack of detail- often by a practitioner who has not spent any meaningful time with the person they are assessing in order to understand their individual circumstances thoroughly. Could this be due to overstretched caseload and lack of capacity with social workers? Is this impacted by the person being uncomfortable disclosing personal information and details about their individual circumstances to a complete stranger? Could this be due to poor assessment skills, or a deliberate way of managing a very stretched resource?
Finally- at the conclusion of the assessment process, if the person has met the eligibility criteria there should be a clear discussion about the ways the person is entitled to receive support via a Personal Budget. Often, the person is only made aware of the option of a commissioned provider service (such as domiciliary or residential care) or a Direct Payment. Often people are talked out of the Direct Payment option by being told it will be stressful and burdensome to manage. Practitioners carrying out the assessment may not have the full complement of knowledge, insight & skill to help the person navigate their entitlement to support in the way which makes most sense for them individually.
In our next few blog posts, we will be expanding on this area of thinking further. If reading this blog post has made you question your own level of knowledge and understanding in relation to the Care Act and people’s rights, you may be interested in joining our Quick Bite for Lunch webinar series on ‘Rights’ which is starting on Weds 20th January 2021 at 12.30pm.
We’ll be exploring the whole area of ‘rights’ in relation to Social Care and Health assessment- sharing our professional experience of supporting many people through the Care Act assessment and Support Planning process in different Local Authority areas across England over the past 10 years.
There will be an opportunity for participants to share their personal experiences and ask questions too.
Visit our ‘webinars’ page for more information or email us: info@imagineer.org.uk to request a booking form.
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space.
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC
Both Liz and Sarah are practitioners, trainers and coaches in Independent Support Brokerage and consultancy for Strengths-Based Approaches with collectively over 40 years of experience in the Health and Social care and community sectors.
Imagineer Development UK CIC is a social enterprise based in the North of England with a national reach; originally set up as a test bed for Independent Support Brokerage in the UK. Imagineer is the hosting organisation for the National Brokerage Network, which is a community of practice for Independent Support Brokers. Imagineer provides a range of training & consultancy services in Support Brokerage, Person-Centred and Strengths-Based Approaches.
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How can a person experience real choice and control to implement good support which works well for them; in a system where professionals and provider services hold all of the power?
Harry is a young adult who has been in the Health and social care system since he experienced a crisis at home with his parents. There had been a number of significant changes in his life to college, community-based activities and natural relationship-based support from people he knew well in his local community. These changes had removed all of the structure and familiar routine Harry needed to function well. Harry found all of the changes really difficult to cope with which resulted in him becoming highly anxious and unwell- eventually being admitted to hospital under the Mental Health Act.
From the beginning, there was a focus on the ‘mental health’ symptoms which Harry was displaying and no acknowledgement of his underlying needs; and (critically) his Autism diagnosis. As a result, Harry then spent several months bouncing between hospital units, the family home and inappropriate provider placements which did not understand how to meet his needs, as his anxiety levels continued to escalate. On a number of occasions, the local police had to assist in ‘subduing’ Harry and physically escorting him to the local A&E department (often causing physical injury and further distress to Harry).
Harry began to be labelled by health and social care professionals as ‘complex’ and ‘challenging’.
Multi-disciplinary meetings involving many professionals to discuss Harry’s support took place without involving Harry or his parents. Very few of these professionals who were making decisions about his future had ever actually met Harry in person! Harry’s anxiety continued to grow because he was not clear about the plan or the options for his future.
While this was happening, Harry had a change of social worker and moved to a new provider placement. Harry’s new placement was out of the local area – far away from his home community, his family and his friends (and definitely too far for Harry to access his home community without planned support to get there). It was intended to be a short-term placement while something closer to home was identified.
After Harry moved, the social worker and the support provider began to tell Harry that he would stay there long-term and that there were no options to return home to his local community. He was told that he should be grateful that there was a place for him to stay! Harry’s desperation increased as he did not feel safe or understood by those who were responsible for his well-being. The social worker and provider organisation actively discouraged the involvement of Harry’s parents (who had been advocating in his best interests the whole time) in meetings to discuss his future support; stating that Harry was an adult now and could make his own choices. Despite this, Harry was still not invited to his own meetings! Information shared with the new provider by the parents about Harry’s processing, communication and sensory needs were dismissed. The parents were made to feel like they were being a nuisance, and were very concerned that they were not being taken seriously.
Harry’s story is real (the details have been changed for anonymity). Sadly, this is not an isolated example.
At Imagineer, we are often approached by people or family members experiencing very similar scenarios of having no power and no voice to influence how their care and support is arranged – often with extremely damaging consequences to their psychological, emotional and physical well-being.
Imagineer offers a range of training and mentoring services to support the knowledge and practice development of practitioners; and also to help people to know and understand their rights.
Visit our training pages which can be found under the menu heading ‘What We Do’ for further details; and subscribe to our mailing list to be kept up to date with what we’re doing.
Further reading:
To keep up to date with citizen’s rights in relation to the provision of advocacy and involving those people who are close to them when planning health and social care support; refer to:
About us:
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space.
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC
Both Liz and Sarah are practitioners, trainers and coaches in Independent Support Brokerage and consultancy for Strengths-Based Approaches with collectively over 40 years of experience in the Health and Social care and community sectors.
Imagineer Development UK CIC is a social enterprise based in the North of England with a national reach; originally set up as a test bed for Independent Support Brokerage in the UK. Imagineer is the hosting organisation for the National Brokerage Network, which is a community of practice for Independent Support Brokers. Imagineer provides a range of training & consultancy services in Support Brokerage, Person-Centred and Strengths-Based Approaches.
Follow us on twitter: @imagineercic
Find us on Facebook: https://www.facebook.com/ImagineerCiC
Find us on https://www.linkedin.com/company/imagineercic
How can you make an informed choice and be in control of your life when you don’t understand what your choices are?
Let’s imagine you’re visiting a friend for dinner, and at the end of the meal, they get their box of ‘Celebrations’ out. (Apologies for the English chocolate reference if you are reading from a different part of the world where these are not available….Celebrations are a box of chocolates with a random selection of miniature varieties of chocolate bars).
The box is already open and it appears that there are only two options left- the ‘Bounty’ sweets and the ‘Milky Way’ sweets.
You really want some chocolate and neither of those brands would be your favourite. But because that’s all you have to choose from, you go with a ‘Milky Way’. Sound familiar?
Now imagine a different scenario where you visit your friend for dinner and they bring out a brand new unopened box- with all of the different varieties to choose from. Would you still choose the ‘Milky Way’?
I know I wouldn’t!! (It would either be a ‘Galaxy’ or a ‘Teasers’ sweet for me).
When one or two options are the only choice you’re given, that’s what you’ll choose from. You might not even think that you have a choice! Maybe you have been told that there isn’t a choice and you should be grateful for what you’re being offered!
What happens when you have the whole range of brands available? Would your choice be different? Probably!
It’s the same with choosing care and support options for planning, arranging and implementing Health, Social Care and Welfare support. Many people are only told about one or two options at the point of assessment. Some people aren’t told that they have a choice at all – they are simply told what they can have.
This simply isn’t right. The Care Act 2014 outlines the range of options available to a person who has been assessed as eligible for support.
So often, people aren’t made aware of their rights when accessing Care and Support.
So how do we help people to make informed choices?
Are you interested in finding out more?
Imagineer offers a range of training & mentoring services to support the knowledge and practice development of practitioners; and also to help people to know and understand their rights.
Visit our training pages which can be found under the menu heading ‘What We Do’ for further details; and subscribe to our mailing list to be kept up to date with what we’re doing.
Further reading:
To keep up to date with case law and to improve your legal literacy in the area of Health & Social Care law, visit:
Luke Clements website
Cascaidr Website
About us:
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC
Both Liz and Sarah are practitioners, trainers and coaches in Independent Support Brokerage and consultancy for Strengths-Based Approaches with collectively over 40 years of experience in the Health and Social care and community sectors.
Imagineer Development UK CIC is a social enterprise based in the North of England with a national reach; originally set up as a test bed for Independent Support Brokerage in the UK. Imagineer is the hosting organisation for the National Brokerage Network, which is a community of practice for Independent Support Brokers. Imagineer provides a range of training & consultancy services in Support Brokerage, Person-Centred and Strengths-Based Approaches.
Follow us on Twitter: @imagineercic
Like us on Facebook: https://www.facebook.com/ImagineerCiC
Follow us on LinkedIn: https://www.linkedin.com/company/imagineercic
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