Escaping the invisible asylum of our health and social care system

Escaping the invisible asylum authored by Shared Lives CEO Alex Fox has been praised as a positive contribution to the thinking around health and social care. Amongst the people leading the tributes have been Simon Stevens CE of NHS England and John Rouse Chief Officer for Greater Manchester. In his book Alex propose some founding principles which would humanise services and outlines how the economics, management and regulation of services would have to change to make this possible. TLAP caught up with Alex to find out more.

What made you decide to write this book?

I wrote this book out of frustration that we are so focused on restructuring organisations and patching up support models which don’t look very much like they offer lives people want to live, when our attention should be on the people and relationships they house. I wanted to ask what health and care systems would look like if they fitted around people’s home and family life, rather than expecting people to fit around services.

What are the main themes that you wanted to explore

I look at the current public service systems which I think are  inadvertently abusive to both the people who need them  and the people who work within them. People may have no choice but to receive intimate personal care from a succession of strangers and care workers may not have the time and freedom to exercise their compassion. I describe alternatives; Shared Lives carers provide regulated personal care to 14,000 people including people labelled as ‘complex’ or ‘challenging’. Shared Lives carers often say the person who lives with them is ‘just part of the family’

In ten years’ time, what do you hope will have changed in social care?

I hope that in ten years’ time we won’t still be tinkering with support models which don’t offer people what they want, or arguing over who will pay for social care. I hope that the emerging movement of ‘asset-based’ community support approaches will form the core of the system, with every support service expected to be delivered in ways which connect people. Truly cost-effective support services will invest more in recruiting and training the right people to create more autonomous, satisfying roles. Most of all I hope that whatever the future of public services looks like it will be routinely co-designed by the people who make long term use of them and their families, with co-ownership models like co-operatives the norm

In your opinion, why could asset-based social care be a game changer?

At present public services work with only a small proportion of the assets available to them: public money and the staff time that it can buy. If we start to see and value all of the resources available to us - including people’s own capacity and potential, the contribution of  family carers, as well as community resources - we could build a health and care system which worked better for people and which was genuinely sustainable.