In our recent conversations with other experienced and esteemed practitioners in the field of health and social care, a regular topic keeps coming up. Why aren’t we seeing real progress in Adult Social Care transformation?
Why now is it still seen as ‘progress’ when a student Social Worker talks about a person they are supporting on the basis of their skills and strengths? This is not new, and it is not innovative. In fact, if a social worker is describing this type of practice, they are merely demonstrating their compliance with the Care Act and Care & Support statutory guidance. We are not seeing change, because those who are the gatekeepers of the change are still seeing ‘new innovation’ as practice which is aligned with what the innovators were discussing and doing 30 plus years ago.
Innovative work is often observed from an external position, where the work of the innovators is recognised, admired, heralded and celebrated but still seen as separate to ‘what we can do’; therefore those that are in a position to make a difference do not recognise the role they have to play in making it happen. They don’t recognise how they can be part of making the difference themselves – always seen as something the the people on the other side of the statutory fence do. It is common practice to attend conferences and online events which are presented as ‘an audience with the innovators’. The problem with this is that innovation continues to be seen external to the audience and the very gatekeepers of change.
So what would it take for people not only to see and admire the ‘innovative’ work but to embed it into their practice, for them to model this approach and build it into what they do, rather than celebrating it as ‘best practice’ and ‘something to aspire to’?
Is this about providing support and guidance; and to be alongside people, building it into their practice as they stretch their comfort zones until it becomes part of their comfort but preventing them from going into the place of panic? Is it about bringing in what is covered in the Be Humankind practitioner experience around recognising your circles of influence, concern and curiosity; functioning from a position of influence and courage whilst being in high states of self care?
Organisations need to focus on building an organisational culture that has psychological safety as a foundation, so that those with the passions, skills and understanding can dare to do things differently and to feel safe and supported in the pursuit of this. We need a health and social care system that is not defined by users and providers but by people being alongside each other in the pursuit of a better life experience.
Wherever the answer lies, it is this dynamic shift in culture and practice we need to see before we can expect to observe any dynamic shift in the way care and support is organised, sourced and experienced.
Independent Support Brokerage creates the shift by working with one person at a time. It does not start with standardisation of processes, forms and templates (which often squeezes out creativity and innovation). Instead it focuses on some key principles:
Listen: to what is happening for the person. Use discovery conversations to understand what the person wants to change or achieve. Start with the strong stuff. Relationships, skills, interests, passions, connections, hobbies. Learn from listening about what a good life looks like for the person. From this foundational information, exploration and planning can happen.
Explore: From the basis of what has been learned from the person, support the exploration of possibilities, opportunities and resources which are available to support the person in what they want to change and achieve. From this stage of the listening, learning and thinking, the person can begin to form some clear ideas of how they want their life to look, and how they would like to be supported with it.
Connect: From the exploration which has taken place, create some ‘maps’ of assets, relationships and opportunities which the person wants to include in their planning. Make connections. Facilitate conversations. Access resources (which could include statutory funding such as a Direct Payment of Personal Health Budget) and secure assets which will support the implementation of the person’s ‘good life’ plan.
Action: Support the bringing together of the final plan. This may need to be signed off by statutory decision-makers, so it is important that the plan meets eligibility and requirements for sign-off. The plan should include costings for any paid-for elements of support, but could also include non-paid elements which still contribute towards the person’s overarching wellbeing outcomes. Once the plan is agreed, an action plan to support the implementation of supports and resources is helpful to ensure that support is put in place for the person. Ongoing support around review and update of the plan may also be helpful.
We’ve been thinking a lot recently about how the neurological levels from Neurolinguistic Programming (NLP) can really help to enable to change to happen authentically, and be lasting. Our founder, Liz Leach Murphy is a Neurolinguistic practitioner, and has incorporated her training and knowledge in this area into our practices as an organisation. As a team, we have recently been reflecting on how this could really help to make things happen where we often get stuck.
When trying to create change in a system, we often don’t take into account the multi-layered dynamics. The need for change is recognised, but often the ‘change process’ works with only one layer of the system whilst overlooking the rest.
People working in different areas or layers of the system will come to the change conversation with their own opinions, and little awareness of the wider impact on the person at the centre of the process or the system. Nobody is listening to each other. The change may be agreed, but is never embedded because the different layers are not all involved together; or they don’t communicate with each other. There is no coproduction. There is no Asset-based approach.
Unless all layers of the system are involved, we will always come across some resistance or a lack of engagement in making real change happen.
In a Health and Social care system, where change is needed, these layers can be composed of:
If these layers can be aligned and congruent, we may experience some element of change.
What are the conditions? Respect, equal power, asset and strengths outlook, a solution focus; but more than anything else, a commitment to really listening to each other and working together to make a change.
The starting point is a shared vision.
With a clear sense of the vision we want to achieve, this then provides the why and the purpose of what we do. We can then explore- “What do we do?”
Checking if the actions we have identified collectively are aligned to the vision and how we do it.
Common barriers to multi-layered change can include:
-Silo working…”I am here to do my job, which is…..” (even if it doesn’t fit with the vision)
-Hero status…” I have been doing this for years. I am the expert, and I have all of the answers”… (even if there is no recognition of the vision or listening to those who are at the centre of the process)
-Time pressures…”We need to get this done by xxx date”….(the date then becomes the driving factor, rather than thinking about what is reasonable, practical and helpful to achieve the outcome)
-Budgetary pressures…”We can only spend this amount during this time frame”…(which can ultimately lead to the wrong outcome and causes higher costs in the long term)
-Forgetting the focus…”The professionals involved all need to have a meeting without the person & their family present”…(which can ultimately lead to misinformed and harmful decision-making which has not included the person or their family)
So… how do we approach a change conversation?
-Start with ‘why’ to identify and agree a clear purpose
-Recognise the expertise, experience & knowledge within the layers of the system or organisation, which can be brought in to effect the change (skills & asset-mapping)
-Make time to discuss and identify each of the neurological levels which need to be addressed to enable the change
The neurological levels start by addressing the environment for the change conversation. They then examine behaviours, capabilities, values and beliefs before arriving at identity.
After looking at each of the neurological levels together, try completing a forcefield analysis together, to identify the forces for change and the forces of resistance. You can then use this as a basis for action planning. (Click here for a template and explainer video).
We can use the neurological levels as a checkpoint for the change.
If you’d like some support with initiating a change conversation; or would be interested in exploring how the neurological levels can help you to drive change in your project or organisation, we’d love to hear from you.
Contact us by email at:info@imagineer.org.uk
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: info@imagineer.org.uk
On the 1st December 2021, the British government published the long-awaited White paper: ‘People at the Heart of Care’.
A week on, we have had opportunity to digest its contents, and to form our thoughts about it. 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 proposals set out within the White paper are backed by the Health & Care Levy announced earlier this year in September, stating that £5.4 billion is being invested into adult social care 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.
Let us know your thoughts- it is helpful for us to hear from people who are interested for different reasons; so we’d love to hear from:
Has this blog been helpful? What do you think about the proposals which are being outlined? If you’re reading this via a social media post, pop a comment below; or alternatively, drop us an email: info@imagineer.org.uk
You can read some of our other blogs here.
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) is involved in developing the Lancashire and South Cumbria Small Supports project.
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.
The Lancashire and South Cumbria Small Supports team are looking for passionate people to help us do this. Get involved or find out more .
Find out more about joining the Small Supports programme and other Small Supports sites in England.
Amanda Topps is an Associate Consultant at Imagineer. You can read her full bio here.
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.
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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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Here’s our year in review. Looking back over 2020 it is easy to be drawn into endless conversations and reflections about the Global Covid-19 pandemic- how it has changed life and society. Whilst it has had a significant impact and influence on our work at Imagineer and the National Brokerage Network this year, it’s also important to step back and review our year from the wider perspective. At the beginning of the year, Imagineer was functioning as a locally-based organisation in West Yorkshire, delivering support brokerage and brokerage management (mainly on a local level); and our training offer mainly focused on the delivery of support brokerage training and person-centred approaches which was delivered in person as classroom-based training.
We started the year by being added to the Think Local Act Personal (TLAP) directory of innovations in community-centred support, for our work on Support Brokerage and Self Directed Support. We became involved in the Social Care Innovation Network and were invited to participate in the Action Learning Set for Self Directed Support. We attended a number of sessions in London for the Action Learning Set and helped to develop the SCIN toolkit for providers and commissioners. The last session we attended was in March just before the first national lockdown started. Elsewhere, we had begun to have some exciting conversations about innovative projects, partnership working with like-minded organisations and new consultancy work. We had 2 social work students on placement with us alongside the Imagineer staff team. We were really excited to get stuck in.
With the national lockdown in full force at the end of March, we knew that we needed to make some decisions to ensure the continued stability of Imagineer and the National Brokerage Network. All of our activity was moved online, via zoom platform. We began experimenting with and developing new ways to connect with people, provide support and deliver training and consultancy. We developed and shared a ‘support your street’ pack for people who wanted to offer help and support to their neighbours during lockdown. We set up and ran weekly ‘brew crew’ online coffee morning sessions as a way to keep some of the people we work alongside connected and socially engaged. These sessions proved really popular, and the topics and activities for each week’s session were planned by the people who attended.
Alongside the need to change the way we were working due to the global situation; we had been developing our business plan to shape the future direction of Imagineer and National Brokerage Network. The business plan took a different direction as we realised that the need to deliver our work online was likely to be a long-term change rather than a temporary response to the Covid-19 pandemic.
We worked alongside Andy Peers to develop our plan, and brought in a number of other partners along the way to help us achieve our objectives. Pivotal have helped us with the development of our website and e-learning platform, Yolk Marketing have been helping us to develop our marketing plan and Pat Bannon has been instrumental in helping us to develop new film content to showcase our work. We developed our digital and technical skills, widening our use of software applications and digital technology to enhance our work online. We were also very happy when Alan Hiscutt accepted our invitation to join our board of Directors as Chairperson earlier in the year, and also Aarron Cammiss who has joined us as a Board advisor. The board of Directors have been focused on steering Imagineer & NBN through the challenges of the Covid-19 pandemic and ensuring we have a stable foundation for us to continue our work into 2021, and beyond. We are very grateful for their wisdom and experience. The input, support and resources provided by all of our partners this year have been so significant in our journey and we would like to thank each one of you who has been involved in the process.
The re-development of the website afforded us the opportunity to review the way the National Brokerage Network was structured, including our membership structure. We have been very busy re-developing the ‘find a support broker’ function on the website and building the organisation directory for our partner organisations. We look forward to seeing the NBN membership growing in 2021 as more people complete their Support broker training and accreditation.
Liz and Sarah began to develop online training content, webinar topics and thought leadership work- leaning into our connections with Citizen Network, Centre for Welfare Reform and other partnership organisations. We dedicated time to develop our networks, connections and relationships to build on our knowledge of what is happening in the health and social care sector; and in the wider conversations about citizenship, communities and welfare. We also embarked on some new project-based work which was enabled via grant funding from The Longleigh Foundation, Imagineer Foundation (Supported by Peoples Postcode Lottery), Calderdale Community Foundation , Charities Aid Foundation, REACH fund, Awards for All and YOR4good. We are also grateful to Beware of the Bull for their support with grant funding applications. We hope to be able to share more about these projects in 2021 as we pick up pace again following the restrictions we have experienced in 2020, due to the pandemic. We’re extremely thankful for the grant funding we’ve received this year enabling us to develop our business model to online delivery and enable the future sustainability of Imagineer and National Brokerage Network.
In the background, Mollie has been working hard to develop our Graphic Facilitation services, online Graphic Facilitation Training and a graphic bank of images for our website, social media and training content; alongside producing some fabulous visual content for different projects we have been working on. Mollie’s unique and distinctive graphic style has become our ‘visual language’ as an organisation, and has brought really vibrant colour and depth to our work- we are very proud! Our favourite pieces of work this year have been where the three of us have collaborated together, bringing each of our skills in training delivery, facilitation, writing and graphicing to provide a dynamic, inspiring and creative experience for the people and organisations we have been working with; and to share our work with wider audiences. Each of us have also continued to work alongside people and families in delivering Independent Support Brokerage and Brokerage Management support in order to underpin our ongoing knowledge and experience as practitioners.
In June, we presented a webinar in association with Centre For Welfare Reform & Citizen Network, entitled ‘exploring the strength of community’; and a few months later, we published a detailed paper via CFWR to complement this.
Later on in November, we wrote and published a further paper entitled ‘what does good look like?’ documenting over 10 years of Support Brokerage delivery and sharing stories of what has worked well, through the eyes of people we have worked alongside. In November, we also began our first ‘quick bite for lunch’ webinar series– designed as short practical sessions which people could attend for 30 mins during their lunch break. We wanted to create an opportunity for networking, staying connected and sharing good practice and creative ideas. By this point in the year, people in our networks had been working from home for many months, and we recognised the importance and value of being able to connect with others informally as an opportunity to reflect and explore new ways of doing things. The sessions were great fun, and well attended. Each session, we would start with a short opening presentation on the topic, followed by time to share stories and ask questions- whilst eating lunch together! We also provided a tool or resource at the end of each session for people to take away and introduce in their work. Our first series focused on person-centred approaches. We will be continuing with these in the new year, and have already developed the content for the next few series! You might want to keep an eye on our webinars webpage for information about new ‘Deep Dive’ and ‘Thought leadership’ webinars we are developing for the new year too!
Towards the end of the year, we had begun receiving invitations to share the work of Imagineer & NBN into regional and national events relating to welfare reform, personalisation of health & social care, strengths-based approaches and community development. We have had some really encouraging and thought-provoking conversations about re-thinking systems and processes which have become ‘stuck’ and we’re really excited to see how these conversations will progress in 2021. Our heart is to see a growing movement of people and communities really in the position to determine how they can become stronger and more connected.
In early December, we released our video ’10 years of Imagineer’ documenting our activity and achievements as an organisation over the past decade. The video was produced by Pat Bannon and we are very grateful for his support with helping us to create this brilliant record of our work so far.
By the end of this year, we will have delivered a total of 6 accredited support broker training courses and over 36 new people trained in Support Brokerage, many of whom have now become members of the National Brokerage Network. We have also delivered some bespoke training to organisations and we have begun engaging with a number of exciting community-based consultancy projects with 4 new organisational partners we are regularly delivering consultancy work and training with. We are also regularly providing mentoring to people practicing Support Brokerage.
Our 2021 diary is already looking very busy and we are so excited to see the impact of our work on the development of Self Directed Support and community-centred approaches in different areas around the UK and beyond.
We know that this year has been a difficult and challenging one for many people (ourselves included) and there have been many losses and sacrifices along the way, but we are so very thankful for the opportunities and development we have seen as an organisation this year. We’d like to acknowledge and thank those people who have travelled with us this year through various stages of the journey, including those who are now on their own different journey whilst we continue to pursue ours. We’ve made some great new friends (as well as strengthening connections with old friends), collaborated on some brilliant projects and had some really exciting conversations about doing things differently. We remain firmly committed to our social mission “to facilitate an empowering society and culture that supports people to live their best lives” and this remains the benchmark for all of our work.
We wish you a peaceful Christmas season and we look forward to 2021 with hope and excitement for the opportunities, connections and partnerships ahead.
Team Imagineer- Liz, Sarah & Mollie
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. Our next Support Brokerage course is running in February 2020. 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.
If you can’t find what you’re looking for on our website, please send us an email: info@imagineer.org.uk
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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