Small and personal - promoting innovative models of support
With the launch of TLAP's new innovations resource, Alex Fox considers why it's needed now
How do you make big changes to how people are supported, when the kinds of support which work best are nearly always those which feel small and personal? TLAP’s new resource - examples of innovative models of community-centred support - aims to show how to do things differently.
James lived in an epilepsy centre for twenty years, where his medical and support needs were labelled ‘complex’. But his goals were simple: friends and a job. He was able to pursue them in the small, homely setting of Andy’s household, when Andy became James’ Shared Lives carer. James moved in and lived as part of a busy household, before moving around the corner into his own place, with close ties to the household when he needs them.
St Joseph’s hospice noticed that there was a gap in the support for families, which was not easily filled by traditional volunteering. When someone approaches the end of life, it can be an isolating experience for a family. Some friends and neighbours withdraw, or worry about ‘intruding’. Agnes said, “I have friends but no-one turns up to see me, why? I needed to go back to the hospital because … if I was in hospital then people would come to visit me.” Agnes was matched with Lucia through the Compassionate Neighbours programme, which enables people to take on a more personal, open-ended role. Lucia says now she and Agnes are “more like family”.
People’s lives can look very small from a helicopter
The changes which Shared Lives carers, or Compassionate Neighbours, achieve in people’s lives are huge for the individual, impacting on their whole life. The challenge for ‘asset-based’ models like these is reaching more people, attracting investment and referrals in public service systems that are designed to make much more specific interventions across very large populations. Large parts of the NHS, for instance, are organised around treating a particular medical condition across populations of hundreds of thousands of people. The senior leaders who control vast council and NHS budgets are expected to be strategic, avoiding getting ‘bogged down’ in detail and taking a ‘helicopter view’. From a helicopter, people’s lives can look very small and insignificant.
The challenge of growing innovative models of care and support
This ‘scaling up’ question has usually been seen as a challenge for the small, personalised, community-based services to overcome. They need to be able to think and act more like the big services, getting more rigorous about collecting and demonstrating their evidence of impact, for instance, or building their back-office infrastructure to compete for big funding contracts. This is based on an assumption that the medicalised, scale-obsessed, risk-selective public service system won’t – can’t – change. It also ignores the many ways in which current public service systems are designed not to admit change, first resisting it through insisting that organisations seeking public funds pass tests which only large, long-established providers can meet, then through assimilating those models which become established. This can be seen in the way that so many charities, once they have started to deliver public service contracts, are gradually negotiated into contracts which remove their distinctiveness and place them in price-based competition with identikit private sector contract-guzzlers.
So growing innovative community models is only half the challenge. The other half is reforming the system in which they are competing for time, energy and money. This means scaling down monolithic, money-hungry services, building citizen voice and ownership into all decision making, and enabling both those who make most use of public services and those who miss out most often to reshape our idea of what success looks like.
TLAP, (Think Local Act Personal) is tackling both sides of the challenge. The Asset-Based Area model sets out the strategic, whole-system changes which need to happen to make an area receptive to more community-based models. Our new resource, the directory of community-centred support, helps a wide range of emerging or small-scale models to be part of that bigger change. The ‘rainbow’ diagram is designed to avoid putting these very human-shaped services into impersonal boxes. It shows that across everything a health and care system tries to do, from helping people get home from hospital, to working preventatively with people who have no formal support need, there are more humanised approaches out there. Some, like Shared Lives, are long-established and national. Some are relatively new but growing rapidly, like Compassionate Neighbours, the Cares Family and Good Gym. Local Area Coordination has a long international history but is newer in the UK. Gig buddies is still small, and proud to ‘keep it punk’.
Together, they are more than the sum of their parts. The new resource will help commissioners piece together a new picture made up from these models, and we hope, many more who submit their information to the new catalogue. The future doesn’t need building from scratch: it’s here already. It just needs finding.
Alex Fox OBE is Chief Executive of Shared Lives Plus and chairs TLAP's national Building Community Capacity network.