The majority of commissioning for Adult Health and Social Care is still focused on fixed and outdated service models which are determined and designed by profit-making service providers; squeezing individual and often complex needs into a broken system which is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
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Here, Leah shares some of her story about caring for her three sons under the age of 18 who are all diagnosed with Autism and a range of other needs.
I have 3 children all of which have Autism, some learning disabilities and possible genetic syndrome. The boys are twins (age 15) and my younger son (age 6). They’re all amazing and despite having the same diagnosis and being twins they present in very different ways and have different needs. All 3 need to be kept safe due to a lack of understanding regarding dangers. All 3 require support to meet daily care needs and this varies from prompts to full assistance. All 3 boys attend special schools, (two out of area). This makes me feel very lucky as it means that their provision has all the adaptations and adjustments required to support them successfully. I stated that this makes me feel lucky and I say that as I witness other parents and carers having a daily fight to secure such a placement. I myself had a long battle too originally, and although it almost cost me my mental health I’m so glad I persevered.
For the time the boys are not at school, then they need support and I’m caring for them physically and directly- be that: sorting medication, clothing, cooking, personal needs, dealing with emotional difficulties…. there’s also tasks and appointments during the school day that need to be dealt with such as preparing for changes to routine, dealing with care plans, EHC plans, genetics, orthotics, OT, SALT, surgery, continence nurse, short breaks and the list goes on. Having said this, again- I’m lucky as I have all this professional input and undoubtedly it takes up so much time; but I know the benefits are immense and some other carers are left to struggle without this level of input. It’s hard to put any actual timings on my caring activities but needless to say that I had to leave my career 6 years ago due to the level of need so that I could become a full time carer to the boys.
All 3 boys are in receipt of Short Breaks and this provides a personal assistant for 3 hours each per week (term time) and 6 hours during school holidays. We also have an amazing family support network that allows us some overnight respite. When not caring, I like to walk and read. I also like to increase my skill set with training and courses (usually SEND related) to better stock my armoury in preparation for the next battle! I also volunteer within community protects and support 2 local SEND charities.
Recognition that having multiple children with SEND increases need. Not having to battle and fight for everything which is constantly the case due to such a lack of funding (so you’re either fighting to get a service or fighting to keep it). Better SEND (Special Educational Needs and Disabilities) guidance that is not open to interpretation; a more inclusive society, and for person-centred approaches to be used across all services. My children’s needs are not the issue. They’re different, not broken but what is the actual issue is a general lack of acceptance and understanding. Being a carer for my disabled children has been so difficult at times, taking its toll on my own health and wellbeing. However, the one thing I’m sure of is that it’s made me a better version of myself and for that (and so much more) I’m extremely grateful.
The reality is hard, the worry for now and for the future can be all-consuming. The constant needs and demands can be draining but each day arrives with some joys (be that a milestone or just a positive day generally). It also arrives with the hope that today is the day that paves the way for true acceptance and inclusion.
Sometimes I feel completely exhausted and out of my depth. Sometimes I feel like I’ve completely lost myself. I feel selfish because I want to take a long bath, wash my hair, wear unpractical clothes, see friends, take a road trip, have a conversation of my choosing; but then sometimes this makes me feel more upset as its a glimpse into another world. I never resent my children and that’s the truth. As I said earlier, they’ve made me a better person; but sometimes I feel tired and overwhelmed especially after a long period of no sleep and when big transitions are approaching as then the worry of the future seems all-consuming. Sometimes I just need a crystal ball to show me how they’ll manage when I’m not around; or if I become ill; or if services are cut any further; or if some parts of society become even less tolerant and more ignorant. Performing any physical and practical needs can be tiring but trying to constantly plan and pre-empt for me is the part that really wears me out- my mind feels to be in constant overdrive.
At Imagineer, we work alongside unpaid family carers in many different ways; but one of the key ways that we can assist is by providing Support Brokerage.
If you are interested in receiving assistance from one of our Support Brokers, please contact us: email@example.com to request a call-back for an informal discussion, or a referral form.
For more information about Carers Week 2021, visit: Carersweek.org
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 firstname.lastname@example.org
People we work with often ask ‘What supports wellbeing?’
The Care Act 2014 has an emphasis on Wellbeing and therefore it is a key aspect of all assessment and planning work in Health and Social Care.
In the practice of Independent Support Brokerage and Person-Centred Planning, we often talk about the concept of ‘purpose’.
However, it’s often missed in the health & social care process as an integral element of a person’s life- so why should we place such emphasis and importance on it?
Research study on purpose and mortality
A recent study conducted in the USA in 2019, followed 6985 adults over the age of 50 to identify a link between life purpose and all-cause mortality rate.
This is huge. This provides evidence which connects a person having a clear purpose in life; with their well-being.
How does Independent Support Brokerage link to the concept of purpose?
Stories of how Support Brokerage has enabled people to pursue their sense of purpose:
Jenny was living in a cramped home with parents as an adult, with no sense of future direction. Through accessing Independent Support brokerage, Jenny was able to move into her own home, employ her own support team using a Direct Payment, and set up her own business.
Billy was facing a future after school which was very lonely and isolated, and without any particular direction. With some Support Brokerage input, Billy became involved in what was going on in his local community, joined local clubs and began speaking at events about inclusion.
Nicky was a lady in her mid-40s. She had been placed in a home for older people because that was the only provision ‘available’ to her, which could meet her complex support needs. The home was out of area- far away from her family and the community she knew well. With input from a Support Broker and key family members, Nicky was able to develop a plan to move into her own home back in her local community. Her family helped her to recruit & manage a team of Personal Assistants using her Direct Payment, which enabled her to be close to her family and back with her relationship networks and connections.
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.
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.
Subscribe to our mailing list 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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