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.
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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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.
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It’s quite common to hear about ‘person-centred approaches, ‘choice and control’, and ‘self-directed support’ in Adult Learning Disability and Autism services; but we don’t often hear about innovations and personalised approaches in the delivery of older people’s care and support arrangements.
Imagineer has been delivering training in person-centred approaches including support brokerage for many years; and recently we were approached by a forward-thinking provider organisation in Devon- Love2care
This organisation provides home care support services mainly to older people across the Torbay area of Devon. They are rated as ‘outstanding’ by CQC and have a really unique, creative and personalised approach to the way they deliver their services.
Traditionally there are 3 main types of service model adopted for the care and support of older people:
The founder of Love2care Devon- Maddy Bird was keen to train her staff team in the principles of self-directed support and to develop their skills as Support Brokers so that they could really open up the way they supported their clients both at home beyond the traditional models of support, and also when there were any transitions into a hospital environment or a change in their care and support needs. Love2care commissioned Imagineer to deliver the full accredited Support Broker training to an initial group of staff at the organisation. Due to Covid-19 restrictions, the training was moved to online delivery, via the Zoom platform.
Maddy talks below about their experiences of doing the training and the impact it is making on their work as an organisation:
Love2care has people at the very heart of the service, and when we talk about ‘people’ we don’t just mean the person we are caring for. We mean them – absolutely, but their loved ones also – the carers who provide paid and unpaid support. We also value our team and employees, as people. We focus on getting to know what matters most on an individual basis – not just feeling like we are completing a set of tasks for someone; but that we are facilitators and part of a support system, as advocates, listening ears, and objective eyes.
I often say to people that Love2care is a person-centred organisation, because although we may be juggling a lot of changes or difficult situations; we are disciplined in our practice, ensuring that others don’t feel that strain. We are careful to ensure that people feel listened to, heard and valued. We then support each person to look at ways to address what it is that they want to achieve.
Our service is very much focused on building & maintaining positive relationships, and having clear boundaries. We work hard to avoid getting caught up in bureaucracy. We truly try to work with the people we support, so that they can live the life they want to. For me, the word ‘facilitators’ is very apparent within the organisation.
My work background prior to Love2care was in a corporate organisation, and my role was ‘brokerage manager’ – working under a ‘prime provider’ framework with my local authority. I loved being able to help secure care and support for people, but what I quickly realised was just how ‘un person-centred’ the processes were. I felt that (for me) care has been a vocation, and a journey, and yet throughout my career I was starting to come further and further away from the person. I was brokering care and support for people whose names I didn’t know, as it was done via an excel spreadsheet. For me, this just wasn’t ok.
I felt that I needed to do more.
I then established Love2care, and through my work, I have just always had a passion for changing that experience. I have been able to do that via Love2care in some areas, but I then had a vision that my team around me would have the competence and the desire to support people more, enhance their lives, and also have meaningful conversations.
I think within our service we regularly felt like we had more to give, but less autonomy through local authority contracts. We equally wanted to support our local community – so there were definitely feelings of restriction and limitations in our role. I developed an idea using support brokerage, and using our CQC registration, which explored a new model of care offering the potential to free up social care time and resources; and work in a much more personalised way with people to self-direct their own support.
We really enjoyed our training. There were a couple of things for me, firstly being able to invest in my team to develop them personally and professionally; giving them a skill set and knowledge base that not all front-line social care staff have the opportunity to normally receive. The training is giving them the confidence and competence to be able to have more in-depth conversations, and autonomy to look beyond a task list for people.
Secondly, what I also took away really positively was that our care and supporting planning was really person-centred already. Recognising that as a home care provider, we had the resources and we were utilising them; but through completing the training we were able to go deeper. I now have more resilience and flexibility within the service, to offer people we may not necessarily need to provide with direct support, but to offer them a brokerage service that means they are feeling heard, and that they can self-direct their own support.
My staff team have the autonomy and confidence to go beyond the norm. They understand how to look at different resources, so people remain independent for longer. Even just our conversations as a team have changed – I feel that we have given people more choice and control – allowing them to make the decisions they want for their lives.
Our local commissioners are really enthusiastic about us thinking differently. We are looking at developing Individual Service Funds (ISFs) within our local teams; however, due to the restrictions of Covid (and now heading into winter pressures), I think there is some delay – even though in one sense and in an odd way, I also feel that because of Covid – we are years ahead.
We will keep doing our thing, and hope that people see that a new model of care could really make a difference.
Surely we have to try?
Are you interested in finding out more?
Imagineer offers accredited support broker training, mentoring and other training/resources relating to self-directed support and strengths-based approaches regularly throughout the year.
Visit our explore our website for further information which can be found under the drop-down menu heading ‘What we do’’ for further details, and subscribe to our mailing list to be kept up to date with future training dates.
To find out more about the work of Love2care- Devon, visit their website: https://love2care.uk/about-us/
About us:
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space.
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC.
Maddy Bird has worked within Adult Social Care for 10 years, in various roles from Community Carer, Care Coordinator, Brokerage Manager in a prime provider commissioning model, and is now founder and leader of an Outstanding Rated organisation, Love2Care Devon – established in 2017.
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How can you make an informed choice and be in control of your life when you don’t understand what your choices are?
Let’s imagine you’re visiting a friend for dinner, and at the end of the meal, they get their box of ‘Celebrations’ out. (Apologies for the English chocolate reference if you are reading from a different part of the world where these are not available….Celebrations are a box of chocolates with a random selection of miniature varieties of chocolate bars).
The box is already open and it appears that there are only two options left- the ‘Bounty’ sweets and the ‘Milky Way’ sweets.
You really want some chocolate and neither of those brands would be your favourite. But because that’s all you have to choose from, you go with a ‘Milky Way’. Sound familiar?
Now imagine a different scenario where you visit your friend for dinner and they bring out a brand new unopened box- with all of the different varieties to choose from. Would you still choose the ‘Milky Way’?
I know I wouldn’t!! (It would either be a ‘Galaxy’ or a ‘Teasers’ sweet for me).
When one or two options are the only choice you’re given, that’s what you’ll choose from. You might not even think that you have a choice! Maybe you have been told that there isn’t a choice and you should be grateful for what you’re being offered!
What happens when you have the whole range of brands available? Would your choice be different? Probably!
It’s the same with choosing care and support options for planning, arranging and implementing Health, Social Care and Welfare support. Many people are only told about one or two options at the point of assessment. Some people aren’t told that they have a choice at all – they are simply told what they can have.
This simply isn’t right. The Care Act 2014 outlines the range of options available to a person who has been assessed as eligible for support.
So often, people aren’t made aware of their rights when accessing Care and Support.
So how do we help people to make informed choices?
Are you interested in finding out more?
Imagineer offers a range of training & mentoring services to support the knowledge and practice development of practitioners; and also to help people to know and understand their rights.
Visit our training pages which can be found under the menu heading ‘What We Do’ for further details; and subscribe to our mailing list to be kept up to date with what we’re doing.
Further reading:
To keep up to date with case law and to improve your legal literacy in the area of Health & Social Care law, visit:
Luke Clements website
Cascaidr Website
About us:
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC
Both Liz and Sarah are practitioners, trainers and coaches in Independent Support Brokerage and consultancy for Strengths-Based Approaches with collectively over 40 years of experience in the Health and Social care and community sectors.
Imagineer Development UK CIC is a social enterprise based in the North of England with a national reach; originally set up as a test bed for Independent Support Brokerage in the UK. Imagineer is the hosting organisation for the National Brokerage Network, which is a community of practice for Independent Support Brokers. Imagineer provides a range of training & consultancy services in Support Brokerage, Person-Centred and Strengths-Based Approaches.
Follow us on Twitter: @imagineercic
Like us on Facebook: https://www.facebook.com/ImagineerCiC
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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//
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