Ahead of tonight’s Panorama, Stephen Chandler, Director of Adult Social Care in Somerset, talks about the challenges of changing social care and asks why we’d want to settle for social care practices from the past.
I had an epiphany about 7 years ago. The old way of focussing resources for people with the greatest needs often resulted in only helping people who were in crisis. But, people’s needs change and so it wasn’t working long term. I was in Shropshire and, with Jenny Pitts, we embarked on some work that had a completely different approach that later developed into the Community Led Support programme.
By using different conversations and a different set of skills we were able to turn assets that people already had within their communities and themselves to create a better solution for them. It sounds simple, but it completely changed how we worked. It enabled us to work with many more people in a meaningful way that helped find more creative solutions to their needs.
This way of working is, not only more satisfying for the people we support, but also for the people doing the supporting. Staff were able to have conversations that truly centred around helping people rather than starting with a conversation about what they weren’t entitled to, which has always been frustrating and upsetting for staff as well as the people in our communities.
One of the challenges attached to the Community Led Support approach was ensuring that people understood that this wasn’t about saving money or passing council responsibilities off to others. It’s about helping communities. Over time staff said the new approach was liberating - more person driven than process driven and that it was leading to more positive results for the people we support.
We now use the same approach in my work in Somerset and staff have told me that their work is more satisfying than it was one or two years ago. They enjoy their jobs, feel empowered and can make decisions that lead to good supports for people.
We’ve also had to rethink the way that we commission support in our communities. We have been used to commissioning “big things” that are very traditional models of services - a “one size fits all” approach. In Somerset, it was particularly challenging to decommission some of these services in favour of a more diverse range of support whilst also developing our micro provider market. We now have over 400 providers who can offer more person centred supports for people whilst they remain in their communities. People were initially sceptical – so it’s been important for us to spend time reassuring them that there’s enough different types of support for people as well as creating opportunities for providers to change the way they work to support people differently.
We believe that this approach is both best for people and better value for money longer term because it’s more effective. Whilst I accept that budgets are a hot topic - I would love to move the Social care conversation away from money. Of course, money is important, but this isn’t about getting hung up on money – this is about providing better care for people and ensuring their independence.
Very few conversations that people start with their council comes from a place of “give me money” they start from a place of “I have this problem, can you help”. So, it’s important to give staff the freedom to think about “what’s the next innovation we can bring to make things better for people” in order to keep providing the best support we can for the most people.
Social care is fearful of creativity and innovation, always worrying about litigation. We need to let people have ideas and run with it. I say to my staff don’t break the law, but if you’ve got a good idea that you want to try out that’s better for the people you support, let’s do it. It has taken time, but staff now know through experience, that I will back them up and support them to be creative in overcoming difficult situations. We’ve carried our approach into the way we work with our NHS partners as it was obvious that we could help impact change quicker if we worked together. I was uncertain about whether we could make it work but we’ve since helped people to leave hospital quicker, with good recovery and needing less support in place.
Hearing stories and sharing the evidence of how we’ve helped people to live good lives or have a good experience when they’ve asked for support helps to bolster my belief that this is the right way forward for Social care.
This country is fixated on a deficit model, rather than thinking about opportunity – we still think about a need rather than a disability. If I was faced with a life changing event and I needed support, I wouldn’t want my council to manage my life, I’d want them to dip into my life and give me minimal support so that I could remain as independent as I was able. We need to stop seeing our ageing population based on their needs, but instead help them to be the best they can for as long as they can.
This is a big issue in Somerset – we need to look further down the line at the needs of the near future. A quarter of our county is shortly about to be over 65 years old. The supports we’ve put in place will be fine for people in their 60’s and 70s, but what about the increasing amount who are 85 years plus. We’ve got to think differently about our offer. In my mind that needs to blend the best parts of a strength-based approach and the best parts of traditional care to create something new, rather than an either-or approach to their support.
To make this work, it’s going to take even more focus on working with our NHS partners. The five year forward plan talks about being more community focused, but what we know in local authorities is, if that change isn’t handled correctly and incrementally, then it’s likely to be wrong.
Despite the care act, we still have a model that pushes more and more people away from services, in the wrong way, without having any support at all. This isn’t sustainable. We know from our experiences of the CLS approach in Somerset, and by talking to other CLS network members across England, Scotland and Wales, that there is collective evidence of how the approach can be adapted to suit most areas. It works. But it has needed great leaders who can empower their staff to embed the change necessary to do it.
Austerity redefined what leadership looked like for Adult Social Care, but the leader of the future will need to be different again - we are forever evolving in our communities and social care must evolve with it. In all other aspects of our lives we push for the latest and most innovative solutions , latest medical breakthroughs – why would we want to settle for social care practices from the past – innovation in our care is better for all of us.
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