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.
People with life-limiting and life-threatening conditions face many barriers in accessing the right support to get the best quality of life and to achieve the outcomes that matter most to them. This is the case not just for health and hospice care — including the delays in referral to hospices and palliative care services and the hesitancy of people and families in accessing these services — but in terms of accessing equipment, psychological and social support, peer support groups, understanding financial entitlements, and other activities and support sources that exist in their community.
Support Brokerage has a very clear ‘person focus’, doing what needs to be done to support people to get to where they want to be in life. Support Brokers work alongside people who are experiencing complicated or challenging life circumstances. They act as independent facilitators, supporting people to plan to live the life of their choice- working directly for the person and supporting them to stay in control, to understand and explore a whole range of opportunities and to confidently take action to achieve their desired outcomes.
The ultimate aim of Support Brokerage is to see people taking full control of their own lives.
We know that people with life-limiting conditions don’t have time to waste; every moment counts in your life, as you live with a limited lifespan. You want to focus on living well, doing things that you enjoy, making memories, spending quality time with those you love, and to achieve that, having good symptom control, the support of services that treat you as a unique individual, accessing benefits, homecare and other entitlements, and all your professionals working together, communicating effectively and sharing information to reduce the burden of health- and care-related admin.
You may have very little time to come to terms with your situation and so you may suddenly be thrust into a new world, a world that speaks a foreign language and seems far too clunky and complicated when you just want to receive the things you need, see the people you need to see and get on with living.
You become a “patient” and your family members instantly become “carers”. This can be tremendously traumatic, on top of the trauma of the illness and its effects on your health, body, abilities, appearance and identity.
Liz Leach (Imagineer Development UK CIC), and Lucy Watts (Lucy Watts Ltd and Lived Experience Learning Ltd) are hosting a webinar on 15th September 2021 (10.30am-12pm) to discuss what gaps exist in the support of people with life-limiting and life-threatening conditions and their families.
We want to explore with people what the gaps are that exist, what difficulties they face, and for us to then see how Support Brokerage can bridge these gaps and provide additional support to get the best quality of life, the necessary care and achieve the desired goals
and outcomes for people facing these conditions.
We want to understand from people with such conditions and family members what can be done to improve their lives and experiences. The webinar will be an opportunity to explore what Support Brokerage is and how it can help people; as well as provide a space for feedback and discussion to gather people’s lived experiences- mapping out what works, what doesn’t and where improvements can be made — and what additional support is needed to achieve these improvements.
Liz is an experienced Support Broker and the Founding Director of Imagineer, with a long history of work in Health and Social care- particularly Self-directed Support and Person-Centred approaches.
Lucy is a Support Broker, Independent Advocate, Consultant and Facilitator who lives with a life-limiting condition, extremely complex medical needs, and accesses hospice and palliative care services.
Meet Angie….she’s been an Occupational Therapist (OT) for 30 years, working in NHS and (more recently), independent OT roles to support people with developing and maintaining their independence and well-being.
The introduction of Personalisation within the Health and Social Care sector made absolute sense for Angie and resonated with her value base and skill set as an Occupational Therapist.
Angie began to explore ways of helping people to take control of their own lives within her work as an OT; and her exploration led her to reading about the concept of Independent Support Brokerage. She began to recognise that her formal OT approach fitted more with the ‘Professional Gift model’, than the ‘Citizenship model’ (which was the approach followed within Independent Support Brokerage). Angie completed her training with Imagineer as an Independent Support Broker, and she joined the Support Brokerage Network (formerly known as National Brokerage Network), which is a community of practice for Independent Support Brokers and organisations who implement the values and approaches of Independent Support Brokerage within their work.
Angie is now part of the Support Brokerage Network, and has written a detailed article about her own individual journey in becoming a Support Broker; in particular- the story of one young man whom she has worked alongside to Self Direct his own support. Angie now uses her professional skill set as an OT combined with the skills and approaches of Independent Support Brokerage to offer personalised, bespoke and enabling solutions and ideas for people to lead their lives in a way that truly makes sense for them:
You can read Angie’s full article here.
You can view Angie’s Support Broker profile here.
You can read more about Support Brokerage here.
If you’re interested in the work of Imagineer; and would like more information about what we do and how to get involved, you can sign up for our mailing list & monthly newsletter here.
In acknowledgement of Deaf Awareness Week 2021; we wanted to share the story of a lady called Emma who is registered as Deaf, that we’ve worked alongside to provide Support Brokerage with.
Emma is registered as Deaf; and she uses British Sign Language and an Alternative & Augmentative Communication (AAC) Device to communicate. We have been working alongside her, enabling her to Self-Direct her own support, using Support Brokerage approaches. To make sure that Emma is in the driving seat for planning and designing her support, we worked out the best way to communicate to organise meetings; which included times, places and who to invite. Emma communicated about this via email as she is able to access this independently and she can reply using the technology available to her.
When we meet in person, Emma has a BSL interpreter available to her which means that she can understand what has been shared or spoken about. To make sure the meeting and the discussion remains focused on and about her, we check any ideas and suggestions put forward with her and await her response or her decision before documenting anything.
We take paper and pens with us whenever we’re meeting with her so we can document ideas and information that will form her plan. This ensures that she can see what is being recorded and can make sure it is correct- we are continuously double-checking with her all the time.
We have also learned certain communication through body language and gestures so that we can develop a mutual understanding without fully relying on the spoken word. All of these approaches have been agreed and developed with Emma as her preferred way of working and communicating with us.
Support Brokerage can be used as a range of approaches to enable people in a very individual and personalised way to take control and remain in the driving seat with making plans for their own care and support.
At Imagineer, we work alongside many different people who approach us with their individual support requirements; and we tailor our approach to them, according to what their preference for our involvement is:
-Tailored communication support
-Visual information gathering and planning techniques
-Flexible arrangements around meetings
-Involvement of Family, Friends and/or Circle of Support
If you would like to know more about Support Brokerage, please visit our website.
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: email@example.com 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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