Imagineer supported a lady who had been identified as eligible for social care support. She was supported by the direct payments team from her Local Authority, but the social worker refused her a direct payment on the basis they did not believe she could manage the arrangement. This resulted in a commissioned provision being identified. The provider of the commissioned support focused on meeting contractual requirements and was not prepared to meet the woman’s needs in a personalised way. The provision broke down on two occasions. A new social worker began working with the lady and arranged for a new provider to meet her, without having a conversation with her about who she wanted to be supported by.
When the lady raised the fact that she wanted to explore other options available to her, the social worker ceased the direct payment, and she was left without support. Imagineer supported the lady to make a complaint via the Local Government Social Care Ombudsman, which was upheld and resulted in the social worker offering to carry out a new assessment. The lady refused because the whole process had been so traumatic. She decided to self-fund her own support in a way which makes sense for her, so she has self-funded a cleaner to help her with domestic tasks, and somebody to take her shopping. Imagineer provided Support Brokerage through each stage of the process until she reached the solution which made most sense for her.
If you’re interested in the range of ways in which Support Brokerage can assist Self-funders in arranging their own care & support, please contact us at: firstname.lastname@example.org
On the 1st December 2021, the British government published the long-awaited White paper: ‘People at the Heart of Care’.
Here is a link for you to read or download the full document. We think it’s really important that people are able to access and understand clear information about things which affect them. Below, we have included a summary of some of the key elements of the paper.
The paper is heralded as a ten year vision for adult social care, and it covers three core objectives:
1. People have choice, control, and support to live independent lives.
2. People can access outstanding quality and tailored care and support.
3. People find adult social care fair and accessible.
Person-centred care is a recurring theme throughout the paper. There is acknowledgement that…”the ambition of the Care Act has not consistently been achieved in the way we would have liked”.
There are some key policies to be introduced over the next three years:
The paper then goes out to break down the three core objectives into finer detail. Under each objective, there is a set of statements, which could be used as a benchmark to demonstrate whether the objectives are being met and embedded at a local level. The statements are written in the ‘first person’ and should be able to stated by anybody drawing on care & support, anyone in an unpaid carer role, or any wider organisations or professionals involved in the delivery of care & support.
The next section of the paper refers to ‘strong foundations’ and makes reference to underpinning legislative frameworks such as: Mental Capacity Act 2005; Health and Social Care Act 2008, 2012; Care Act 2014 and the Health & Care bill which is currently going through parliament.
In addition, there is further reference to Mental Health Act 1983 (which is currently going through reform); Autism Act 2009; Children & Families Act 2014 which add to the wider legislative framework surrounding Social care.
There is also a statement of intention to publish a further White paper on the integration of health & care services.
The paper sets out some of the current challenges such as:
The next section of the paper emphasises the concept of ‘Right care – Right place – Right time’, with an emphasis on improving the range of housing options available to people and ways to support people to live in homes and communities they choose.
There are a range of case studies throughout the paper which illustrate the themes being presented.
One of the really stand-out elements is the emphasis on unpaid carers (including young carers being recognised), and the willingness to explore models of support for carers that are working well in other countries such as Germany & Australia.
The White paper states the intention for the Department for Education to amend their schools census to clearly include ‘Young carer’ data; to raise the visibility of young carers within the school system. This will also help to build the picture of the impact of ‘caring’ on school attendance, educational progress and attainment.
There is also a section on supporting people with autism and learning disability into employment.
The paper goes on to lay out further details about improving the Health and Social Care workforce (including support with recruitment, retention and skills/training); and finally how it is going to work with Local Authorities to stimulate new and innovative ways of providing support and a good range of choice for people at a local level.
The CQC (Care Quality Commission) as a regulatory body will have a new duty to review how partners of Integrated Care Systems (ICSs) are working together and also to review how Local Authorities deliver Adult social care functions. Under the Health & Care bill (currently going through parliament) the CQC will assess how Local Authorities are meeting people’s needs.
There is an example set of assessment criteria given within this White paper:
The paper concludes by outlining next steps, which mainly cover the introduction of working groups on a number of the new policies being introduced.
We talk about being person-centred in social care, but what does this mean in the context of supporting people with learning disabilities or autistic people to leave a long-stay hospital or assessment and treatment unit?
When we talk to leaders in adult social care they openly admit “we can do better for people” with regards to community support and getting a good life.
One national project, Small Supports, is providing some answers and raising some questions about how we support people and commission services differently.
Personalisation and being person-centred is at the heart of this project, with twelve sites nationally supporting the growth of small providers. Amanda (from the Team at Imagineer) has been involved in developing Small Supports projects in a number of areas.
Small Supports are small, local organisations who work with people with learning disabilities and/or autism, who have experienced difficult or traumatic life events and who need a different approach to support them to leave hospital.
These new providers will focus on putting the person in the driving seat by building strong relationships with them and their family and circle of support. Fundamental to this is their willingness and ability to listen deeply to the person, their aspirations and hopes
for their future and then to help them choose and plan what a great life looks like for them. Conversations about support and risk follow that.
The belief is that remaining small enables the leaders of the organisation to keep in touch with everyone, the people being supported, their families and those providing the support. Small is also very much about quality. Building strong relationships of trust with the individuals they support and their families, the commissioners and the community teams is vital to ensuring quality continuous support. Being able to ‘touch the sides’ of the organisation means that when challenges arise and changes are needed they can be spotted early and acted upon quickly.
Being small and local also means the leaders and paid supporters in the organisation are rooted and engaged in their community. They are able to build links with the person to their community based on their assets and strengths.
People are therefore able to contribute to society and build relationships outside of their family and paid support, something Small Supports strongly advocates. Focusing on individual’s aspirations and building intentional relational networks with and for the
person means that anything becomes possible, including friendships, finding love, getting a job, being a good neighbour and regaining health and happiness. Whilst these things may not seem like a great ask for most people, for many people who have lived for years in locked environments these important life experiences may feel out of reach. Small Supports is aspiring to change this by putting the person at the centre of the decision making in their life including focusing on what a good life looks like for them.
This is where quality Support Brokerage fits in. Being able to use a personal budget in the form of a direct payment, third party health budget or individual service fund offers a way to use creative and strengths based approaches to build a support plan directed by the person and their family. Every person has unique strengths, assets, gifts and skills and these are the starting point for building a dynamic support plan with the person in the driving seat. Looking at the person’s aspirations first, instead of a ‘one size fits all’ approach to buying support services; a personal budget enables the person to be directing their plan and how they want to spend their money so that the support wraps around them. The provider is there to support the individual and broker services as directed by the person. This will look very different for each person. Support Brokerage enables this bespoke and highly creative approach to designing a support plan which makes sense to the person; and drawing on all of the other strengths, connections and resources available to the person which can help to make their plan a reality..
What Small Supports organisations learnt was that compromising on control and aspirations is when things start to go wrong. Using an individual service fund or a personal health budget enables the person to be in control, supported by their family and the provider. This type of personal budget offers flexibility like a direct payment.
Recognising that daily life is not on a schedule, is not predictable and is not the same every day. The person, their family and network supported by their provider can flex the support around the person’s choices and changing needs and if something unexpected comes up, they can adapt. This is not necessarily the case with a commissioned or managed budget (sometimes referred to as a ‘notional’ budget), where they might have to ask for a social care review to change the support plan, which may not happen immediately.
An individual service fund (ISF) is where the person and their family might like the idea of directing their support and being in control but don’t want the responsibility of managing the finances, staff and payroll. The provider or a third party helps them work out how to spend their budget and create their support plan and is accountable for it on their behalf; while the person remains in control of their support.
People who have successfully established their new Small Supports organisation tend to be people who have a background in providing or commissioning services.
Some are people with lived experience and family members, some are learning disability nurses, commissioners or social workers. However, they are bold and compassionate leaders committed to human rights, who understand the value of their community, aspire to provide high quality, local support and plan to remain small but sustainable- not supporting more than 5 people in their first year.
All Small Supports sites are actively looking for brave values-driven people who want to explore with them how to set up their own dynamic citizen-focused great Small Supports organisation. They will need to be tenacious, pro-active, flexible, good at problem-solving and passionate about making a difference and supporting people to live a great life.
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: email@example.com to request a call-back for an informal discussion, or a referral form.
For more information about Carers Week 2021, visit: Carersweek.org
In acknowledgement of Deaf Awareness Week 2021; we wanted to share the story of a lady called Emma who is registered as Deaf, that we’ve worked alongside to provide Support Brokerage with.
Emma is registered as Deaf; and she uses British Sign Language and an Alternative & Augmentative Communication (AAC) Device to communicate. We have been working alongside her, enabling her to Self-Direct her own support, using Support Brokerage approaches. To make sure that Emma is in the driving seat for planning and designing her support, we worked out the best way to communicate to organise meetings; which included times, places and who to invite. Emma communicated about this via email as she is able to access this independently and she can reply using the technology available to her.
When we meet in person, Emma has a BSL interpreter available to her which means that she can understand what has been shared or spoken about. To make sure the meeting and the discussion remains focused on and about her, we check any ideas and suggestions put forward with her and await her response or her decision before documenting anything.
We take paper and pens with us whenever we’re meeting with her so we can document ideas and information that will form her plan. This ensures that she can see what is being recorded and can make sure it is correct- we are continuously double-checking with her all the time.
We have also learned certain communication through body language and gestures so that we can develop a mutual understanding without fully relying on the spoken word. All of these approaches have been agreed and developed with Emma as her preferred way of working and communicating with us.
Support Brokerage can be used as a range of approaches to enable people in a very individual and personalised way to take control and remain in the driving seat with making plans for their own care and support.
At Imagineer, we work alongside many different people who approach us with their individual support requirements; and we tailor our approach to them, according to what their preference for our involvement is:
-Tailored communication support
-Visual information gathering and planning techniques
-Flexible arrangements around meetings
-Involvement of Family, Friends and/or Circle of Support
If you would like to know more about Support Brokerage, please visit our website.
When we’re delivering training or webinars about Support Brokerage we often explain it using the analogy of a car and a journey.
The car represents a person’s life. The person is the driver of their own car. This represents the core principle of Support Brokerage, which is that the person is in the driving seat.
In other words, as Support Brokers- in all of our practice and interactions we are continuously revisiting the principle that the person we are working alongside is taking the lead in making decisions about their life- where they want to be going, what they want to be doing, how they want to be supported and who will be involved. This is a core principle of Self-Directed Support.
Now to continue with our analogy, all cars need fuel for the journey.
Some people need assistance with putting ‘fuel’ in their car. This is where the Support Broker can become involved. Support Brokers are multi-skilled individuals who come from a range of different backgrounds. They have knowledge and experience which they can bring to assist the person they work alongside. Support Brokers can be people with lived experience, people who have worked in the Social care sector, Health professionals, Housing professionals or Community/Third sector workers. The Support Broker brings their range of skills, experience and knowledge, and uses this to assist the person with adding ‘fuel’ into their car. The ‘fuel’ we see in the image is referencing a range of different ‘strengths-based’ approaches which a Support Broker can lean into as they are working alongside the person to assist them with achieving their objectives.
The term ‘Support Broker’ is neither a job title, nor a job description, because the tasks which a Support Broker carries out will vary with each person they work with. Remember that the person is in the driving seat, and they will determine the remit and involvement of the Support Broker.
Now that the fuel has been added to the car, it is ready for the journey.
Remember, the person is in the driving seat. Once they have fuel in their car, they may decide that they need no further assistance from the Support Broker and decide to continue the rest of their journey independently. However, they may require some support to plan their journey and/or navigate the various destinations. In the image below, you will see that there is a passenger in the rear seat of the car. This is the Support Broker, who is holding a map and calling out directions- all the time acknowledging that the person is still in the driving seat and they are in control of the journey. At any point, the person could ask their Support Broker passenger to get out of the car!
For some people, they may have multiple ‘passengers’ in their car- these may be close family members or friends & members of their local community who are very involved in the person’s life; alongside the Support Broker who is also a passenger. We sometimes refer to this (or formalise this arrangement) as a ‘circle of support’. The principle of ‘passengers’ and the person in the driving seat still applies.
The journey of Support Brokerage may include visiting one or more destinations which help to bring the person closer to achieving their objectives. These include the ‘keys to citizenship’ of: Life, Love, Help, Purpose, Money, Home and Freedom.
The Support Broker may be tasked with carrying out specific actions as part of this journey, which could include person-centred planning, support with navigating the social care or health assessment process, identifying resources which help to achieve the person’s objectives and developing a support plan. The range of tasks is broad and should not be defined as an exhaustive list.
As with any journey, the longer we spend in the car and in the driving seat; the more confident we become and the more skilled and experienced we become at driving the car. This is also true of the input of a Support Broker. As the person becomes more confident and skilled at advocating for themselves, knowing and understanding their rights and being able to take the lead in discussions about their own support, the Support Broker is able to step back with the aim of not being needed at all in the end. For some people, it may be that they will always need some element of involvement from their Support Broker, but this should never be assumed and should regularly be revisited as a conversation with the person about how they feel things are going and how confident they feel about doing things independently.
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. For further details, visit our website.
You can also subscribe to our mailing list if you would like to be kept up to date with what we’re doing.
If you can’t find what you’re looking for on our website, please send us an email: firstname.lastname@example.org
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It’s quite common to hear about ‘person-centred approaches, ‘choice and control’, and ‘self-directed support’ in Adult Learning Disability and Autism services; but we don’t often hear about innovations and personalised approaches in the delivery of older people’s care and support arrangements.
Imagineer has been delivering training in person-centred approaches including support brokerage for many years; and recently we were approached by a forward-thinking provider organisation in Devon- Love2care
This organisation provides home care support services mainly to older people across the Torbay area of Devon. They are rated as ‘outstanding’ by CQC and have a really unique, creative and personalised approach to the way they deliver their services.
Traditionally there are 3 main types of service model adopted for the care and support of older people:
The founder of Love2care Devon- Maddy Bird was keen to train her staff team in the principles of self-directed support and to develop their skills as Support Brokers so that they could really open up the way they supported their clients both at home beyond the traditional models of support, and also when there were any transitions into a hospital environment or a change in their care and support needs. Love2care commissioned Imagineer to deliver the full accredited Support Broker training to an initial group of staff at the organisation. Due to Covid-19 restrictions, the training was moved to online delivery, via the Zoom platform.
Maddy talks below about their experiences of doing the training and the impact it is making on their work as an organisation:
Love2care has people at the very heart of the service, and when we talk about ‘people’ we don’t just mean the person we are caring for. We mean them – absolutely, but their loved ones also – the carers who provide paid and unpaid support. We also value our team and employees, as people. We focus on getting to know what matters most on an individual basis – not just feeling like we are completing a set of tasks for someone; but that we are facilitators and part of a support system, as advocates, listening ears, and objective eyes.
I often say to people that Love2care is a person-centred organisation, because although we may be juggling a lot of changes or difficult situations; we are disciplined in our practice, ensuring that others don’t feel that strain. We are careful to ensure that people feel listened to, heard and valued. We then support each person to look at ways to address what it is that they want to achieve.
Our service is very much focused on building & maintaining positive relationships, and having clear boundaries. We work hard to avoid getting caught up in bureaucracy. We truly try to work with the people we support, so that they can live the life they want to. For me, the word ‘facilitators’ is very apparent within the organisation.
My work background prior to Love2care was in a corporate organisation, and my role was ‘brokerage manager’ – working under a ‘prime provider’ framework with my local authority. I loved being able to help secure care and support for people, but what I quickly realised was just how ‘un person-centred’ the processes were. I felt that (for me) care has been a vocation, and a journey, and yet throughout my career I was starting to come further and further away from the person. I was brokering care and support for people whose names I didn’t know, as it was done via an excel spreadsheet. For me, this just wasn’t ok.
I felt that I needed to do more.
I then established Love2care, and through my work, I have just always had a passion for changing that experience. I have been able to do that via Love2care in some areas, but I then had a vision that my team around me would have the competence and the desire to support people more, enhance their lives, and also have meaningful conversations.
I think within our service we regularly felt like we had more to give, but less autonomy through local authority contracts. We equally wanted to support our local community – so there were definitely feelings of restriction and limitations in our role. I developed an idea using support brokerage, and using our CQC registration, which explored a new model of care offering the potential to free up social care time and resources; and work in a much more personalised way with people to self-direct their own support.
We really enjoyed our training. There were a couple of things for me, firstly being able to invest in my team to develop them personally and professionally; giving them a skill set and knowledge base that not all front-line social care staff have the opportunity to normally receive. The training is giving them the confidence and competence to be able to have more in-depth conversations, and autonomy to look beyond a task list for people.
Secondly, what I also took away really positively was that our care and supporting planning was really person-centred already. Recognising that as a home care provider, we had the resources and we were utilising them; but through completing the training we were able to go deeper. I now have more resilience and flexibility within the service, to offer people we may not necessarily need to provide with direct support, but to offer them a brokerage service that means they are feeling heard, and that they can self-direct their own support.
My staff team have the autonomy and confidence to go beyond the norm. They understand how to look at different resources, so people remain independent for longer. Even just our conversations as a team have changed – I feel that we have given people more choice and control – allowing them to make the decisions they want for their lives.
Our local commissioners are really enthusiastic about us thinking differently. We are looking at developing Individual Service Funds (ISFs) within our local teams; however, due to the restrictions of Covid (and now heading into winter pressures), I think there is some delay – even though in one sense and in an odd way, I also feel that because of Covid – we are years ahead.
We will keep doing our thing, and hope that people see that a new model of care could really make a difference.
Surely we have to try?
Are you interested in finding out more?
Imagineer offers accredited support broker training, mentoring and other training/resources relating to self-directed support and strengths-based approaches regularly throughout the year.
Visit our explore our website for further information which can be found under the drop-down menu heading ‘What we do’’ for further details, and subscribe to our mailing list to be kept up to date with future training dates.
To find out more about the work of Love2care- Devon, visit their website: https://love2care.uk/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.
Maddy Bird has worked within Adult Social Care for 10 years, in various roles from Community Carer, Care Coordinator, Brokerage Manager in a prime provider commissioning model, and is now founder and leader of an Outstanding Rated organisation, Love2Care Devon – established in 2017.
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