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.
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.
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