The majority of commissioning for Adult Health and Social Care is still focused on fixed and outdated service models which are determined and designed by profit-making service providers; squeezing individual and often complex needs into a broken system which is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
To keep up to date with Imagineer & Support Brokerage Network, sign up for our mailing list.
At Imagineer, our day-to-day team consists of the three of us: Liz, Mollie & Sarah.
Although we didn’t deliberately set out to be a female-only team (as we do have male board members, and have had male staff working in the organisation previously); we have landed here for now, and we are a formidable trio!
We wanted to take the opportunity to celebrate our little team on International Women’s Day 2021, and also to recognise and honour some wonderful women who have influenced us and continue having an impact on our work.
Imagineer started 12 years ago with Liz, who was heavily impacted by the work of many other female visionaries working for a better world- one where everyone could be equal, recognised first and foremost as citizens with gifts and skills, rights and responsibilities. Liz’s early work in person-centred planning shaped the future direction and vision of Imagineer.
Mollie and Sarah joined the team at later points (both inspired by Liz’s work)- Mollie bringing her wonderful graphic skills, and Sarah bringing her writing skills as well as many years of collective experience in the Health and Social Care sector.
Much of the work which influenced the development of Imagineer and Independent Support Brokerage in the UK came from women such as Beth Mount, who wrote many wonderful books and developed beautiful person-centred planning approaches using creative and visual techniques. One of the approaches she is well known for is the creation of beautiful quilts which help to tell a person’s story. You can read more about Beth Mount’s work and the different resources she has developed here.
Another key influencer of our work was the wonderful Judith Snow, who was an advocate for inclusion and one of the early pioneers of Individual Budgets and Circles of Support. You can read more about Judith’s life and work here.
Connie Lyle O’Brien (and her husband John) have taken a lead in thinking and creating new ways of relating to and supporting disabled people over the past 40 years, on a global basis. In addition to developing many of the person-centred planning systems used internationally, training thousands of facilitators and health & social care workers; they have also been authors of numerous inspirational publications and resources.
Marsha Forest (& her husband Jack Pearpoint) founded the Centre for Integrated Education and Inclusion Press International. Marsha Forest was a remarkable leader, advocate and champion of inclusion for all.
Finally, we couldn’t let this day pass without honouring and remembering our wonderful Beth Fields who was part of our team for a number of years and who is sadly no longer with us. Beth worked hard to develop and grow our ‘Beat It’ music project which started a number of years ago as a result of the people we worked alongside expressing an interest in (and a love for) music. The people who Beth worked alongside and the musicians she supported are continuing to use their gifts and skills to bring music, life, energy and fun to the world- this is an enduring legacy which will continue to have an impact in the lives of people and communities she was involved with.
One of our core team values at Imagineer is fun, and we highly value every element of our work (past and present) which enables us to continue holding this as a value. The featured photo is a screenshot of our 2020 (lockdown) Christmas party, which we had over zoom. We had takeaway & wine, played silly games together and exchanged gifts. Mollie had made beautiful personalised hand-designed team mugs for each of the three us, which you can see in the picture!
Women over the years have been responsible for many breakthroughs in societal values, equality and inclusion. They have tirelessly promoted well-being and welfare for those who often don’t have a voice. We have much to thank women for and celebrate; and we continue to honour their legacy by building on it with our own work. Today, we want to celebrate, recognise and value all of the wonderful women we are connected with through partnering in shared vision, values and activities which help to make the world a better place. There are too many of you to mention; but we see you and we are grateful for you.
We’d love to hear about women who have influenced you and your work in relation to Health and Social Care, Community Development, Well-being and Welfare. Please do get in touch with us to share your thoughts with us at info@imagineer.org.uk
Yesterday (16th Feb 2021), we had the privilege of attending and sharing about our work at ‘It’s our community’ online conference, hosted by Citizen Network.
We wanted to share a short summary of the event, and encourage you to visit the YouTube channel to watch the event if you haven’t already done so.
Here’s the timetable of speakers:
Click here to watch the full conference or any of the individual talks.
We heard from a diverse range of speakers all bringing their perspectives about citizenship, life in the community and how social care impacts their lives- both the good and the bad experiences. Many of the stories we heard were raw and painful. They illustrated the struggle so many individuals and families go through in order to get good support, and the vilification of those people in society who experience some of the greatest challenges.
We heard from professionals working within (and external to) the statutory systems which underpin our current social care system; and we heard some great examples of innovation, creative use of resources and stories of people and communities really being able to find their own solutions which could be cost-effective and enduring.
Liz shared how 12 years of delivering Support Brokerage to people and families had demonstrated that things could be done differently and really effectively- using resources creatively, flexibly and often at a much lower cost- by placing the resources and the control in the hands of the people and communities who needed them. The solutions to people’s needs often reside within the communities where they live. The current system is based very much on the medical model and the professional gift model- focusing on need, risk, deficit and diagnostic labels. The resources we need are already there, but need to be realigned and used in a way which makes sense to the people who need them. Our social care system is still struggling with the concept of relinquishing power and control into the hands of the people who use it. We need a radical reform of social care, where there is no charge for care to the citizen. Access to care and support should be a universal right. (2:10:50 into the conference, if you wish to listen specifically to Liz)
The summing up of the event was shared wonderfully and articulately by Simon Duffy (Centre for Welfare Reform) – commenting in response to Shadow Social Care Minister- Liz Kendall; that we need to think about what the basis of a long-term new vision for social care is. What we’ve seen for three decades is a drift- that the consensus building process has failed to bring about the changes we’ve been talking about for the last few hours (during the conference). This conference was framed as a progressive vision for social care. We first need to create a coherent attractive vision that ordinary people want. That work needs to be done by working together, particularly disabled people in the community, & civil society. Nobody is making firm commitments beyond platitudes to say this is the model we want and this is how we will fund it. It needs to be properly funded for it to happen.
The vision is not hard, but it does require real work. We can evidence this by working together, and there’s a lot we can do ourselves. The other things we ultimately need national politicians to do will be easier if we can lead the way. Let’s reinvent social care.
Citizen Network will be publishing all of the films and a report following the conference.
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.
Follow us on twitter
Find us on Facebook
Find us on LinkedIn
We connect with the world around us via People, Places and Opportunities. People who receive Health and Social Care service-based support often have limited networks which mainly consist of paid workers, professionals who are in their life on the basis of their label or diagnosis, and limited friend/family involvement. The potential and momentum of people’s relationship connections can really begin to unlock opportunities; which do not reside within formal statutory or service-based provision.
A key aspect of Independent Support Brokerage is exploring people’s connections. Not only does this help us to establish who the important and significant people in a person’s life are; but we can begin to identify opportunities to build further connections through which relationship ‘chains’ can be created. This approach can provide a springboard into new networks, communities and opportunities, helping to reduce dependency on statutory provision which is often very costly and exists on the basis of a financial transaction rather than a relational connection.
Supporting people to identify and develop their connections can result in an enriching experience for all involved, and can help to develop community-based resilience over time.
Who we know, and who they know!
Where we go and who we might bump into or develop a connection with when we’re there!
What we’re interested in, which we might have in common with other people we could then form a connection with on the basis of shared interests, skills, passions, hobbies or beliefs.
One particular way we can support people to identify and develop connections is through using an approach called ‘community treasure chest’.
The focus of the approach is the principle that individuals within groups of friends/neighbours, a circle of support or small community-based grass-roots organisations all hold ‘treasure’ which can be gathered to share with the group; and this ‘treasure’ provides points of connection which enable them to achieve outcomes & objectives.
As individuals within the group, you each take turns to share information about people you know who may be useful for others to connect with; your passions, obsessions & interests; your skills, training and knowledge; and something you are interested in learning about or doing. By doing this, key information is gathered which can then inform action planning, support planning or even business planning.
In the scenario where a Support Broker is working alongside a person to help them self-direct their own support, they can use this approach to build on the information they have already gathered about what the person is interested in; their hopes, dreams and aspirations. This helps the Support Broker to identify where connections can be made from the person’s existing network in order to grow those connections and relationships further.
A gentleman used a regular bus route and the bus driver got to know him. The gentleman would always get off the bus at the same place, and while he was waiting to get off, they would always have a chat together. The gentleman’s family & friends noticed that he talked about the bus driver a lot and they explored how they could help to build on that relationship. The bus driver frequented a local pub and invited the gentleman to join him for a drink. In time, the gentleman got to know other people in the pub and became involved in many social activities which were connected to the pub community such as quiz nights, karaoke etc. It was discovered that the gentleman supported the same Rugby team as other people he spent time with at the pub, and he was invited along to go to the matches together with them. Over time, he began to make friends with other supporters who attended the same matches and he became involved in a much bigger community network on the basis of his shared love of Rugby. These connections grew from the basis of one initial relational connection in the gentleman’s local community and his day to day routine.
Working with people’s connections is a ‘Strengths-based approach’. In other words, it is focusing on things which are positive, good and strong in the person’s life and then building on those things; rather than starting from a perspective of ‘need’, risk or deficit.
We’d love to hear from you about your stories and examples of how people are being supported to build their relationships and connections. Please email us info@imagineer.org.uk if you have a story or example you’d like to share.
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. Consider signing up for our ‘Quick bite for lunch’ webinars which explore practical ideas taken from Independent Support Brokerage. These practical approaches can be embedded within your practice. We are also planning a series of ‘Deep Dive’ webinars for the new year, which will be advertised on the ‘Webinars’ page of 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.
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
Find us on Facebook
Find us on LinkedIn
Leaders and decision-makers within the health and social care sector generally grasp (and subscribe to) the concept of Personalisation and Self-Directed Support; but often feel ‘stuck’ in relation to the systems, structures and processes that they are required to work within.
Having a simple lens by which to review policy and practice could be a catalyst for real and lasting change.
Let’s explore this in a little more detail.
Independent Support Brokerage is an approach which strongly aligns with the theory of self-determination and was first developed by families of people with complex needs, called the Woodlands Parents’ Group in British Columbia, Canada in the 1970s.
When the person is in the driving seat of their own life, amazing things can happen; and solutions and opportunities can be discovered which were not even considered through the narrow lens of commissioned provider services and statutory provision from Health and Social Care. Elements of Support Brokerage exist in many different models and approaches, but authentic and truly Independent Support Brokerage is rooted in a wide range of Person-Centred Practice and Strengths-Based Approaches such as:
Some of the barriers and challenges presented by the current Health and Social Care system include:
Our experience as practitioners of Independent Support Brokerage has shown that many of these barriers and challenges can be overcome when the following conditions are present:
The mechanisms and legal structures enabling these conditions to be present already exist, and it is happening in small pockets around the UK.
So why isn’t it happening everywhere? There is a growing groundswell of momentum towards the radical transformation of the welfare state. The Health and Social Care sector forms one part of the puzzle. There are many refrains of ‘Coproduction’, ‘Personalisation’, ‘Strengths-Based Approaches’ and ‘community development’ being sung by different groups wanting to see change. If we gather our voices together collectively and sing as a choir; we could weave our harmonies together to create a symphony of citizenship, inclusion and equal rights for all.
Do you want to join the chorus?
We are in the process of developing a set of quality standards which map across to other aligned quality standards and outcomes indicators for the health and social care sector. Visit our website: https://www.imagineer.org.uk// to sign up for updates; and read our latest paper: ‘What does ‘good’ look like? to find out more.
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 testbed 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 in Support Brokerage, Person-Centred and Strengths-Based Approaches.
Further reading: What does ‘good look like?: https://www.imagineer.org.uk//wp-content/uploads/2020/08/What-does-good-look-like.pdf
Sign up to our mailing list to be kept updated on our work in developing quality standards for Person-Centred practice and Self-Direction: https://www.imagineer.org.uk//
Follow us on Twitter: @imagineercic
Like us on Facebook: https://www.facebook.com/ImagineerCiC
Follow us on LinkedIn: https://www.linkedin.com/company/imagineercic
© 2023 Imagineer Development UK CIC | Company Number 8243143
