Alex Fox CEO, Shared Lives Plus Co-Chair, Think Local, Act Personal

1. Alex Fox CEO, Shared Lives Plus Co-Chair, Think Local, Act Personal Chair, Care Provider Alliance Karl and Clare with Shared Lives carers Blossom and Mike, at their wedding, before moving to live independently Kent Shared Lives

2. Background Shared Lives Plus is the UK network for family-based and small-scale ways of supporting adults. Our 4,500 members are Shared Lives carers and workers, Homeshare programmes and micro-enterprises. Think Local, Act Personal is the sector-led partnership developing and implementing ‘personalisation’ in social care. The Care Provider Alliance brings together all the representatives of independent social care providers.

3. What is personalisation? Personalisation is not just personal budgets or Direct Payments. To understand what it is, we need to look at where it came from.

4. 1970s, early ‘80s A sector characterised by: • disabled people warehoused in long-stay institutions; • a medical model of disability and low expectations of people with long term conditions; • ‘one size fits all’ state social care services, centrally planned and organised, with little individual or family control. But also: • community and whole-family social work approaches • huge contribution from unpaid family carers (was and remains poorly recognised and valued by the state.)

5. Community care reforms The Griffiths Report (1988) and others led to: • closure of nearly all long-stay institutions for people with disabilities • huge shift of care for people with disabilities & mental health problems, into community-based settings But: • model remained individual (not family / community) focused • needs, not asset-based • led by professionals and decision makers, not people

6. SDS and personalisation Self-Directed Support is the principle that people should have as much choice and control as possible in decisions which affect their lives, such as service planning. Direct Payments introduced in 1995, but take-up remained low until the development of personal budgets.

7. Putting People First 2007 Putting People First (2007) set out a vision for ‘personalisation’ with four equal parts: • A more universal system • Prevention • Social / community capital • Self-Directed Support, choice and control for service users Significant increase in Direct Payments (25% of personal budgets, or 44% of cash value). Huge increase in personal budgets (340,000 people; £1.57bn). But less evidence of the whole vision. Why?

8. Personalisation reforms limited by ‘needs-based’ system Adult social care system remains needs-based: • Eligibility and needs assessment: “Are you vulnerable and needy enough for us to talk to you?” • Up-front means-testing: “Are you poor enough?” • Medicalisation and labelling: “Our experts have decided upon your needs and category.” • Complex jargon, processes and resource allocation systems: “You need a guide to negotiate our care pathway.” • Dependence: “We can help you as long as you have critical needs and your family refuses to help.” • Overlooks importance of relationships and active citizenship.

9. From better services to better lives • Choice and tailored services are important, but choice doesn’t guarantee a new range of services • Individual budget control hasn’t led to commissioning power • Choice is illusory without family/user-led service design • …. and even a great service doesn’t guarantee a great life. • A good life usually involves choosing and contributing to a family and community: it’s about our relationships and responsibilities, as well as our personal development and entitlements. • eg in Shared Lives people can contribute to their household, family and community, as well as receiving support.

10. A strength-based approach ‘Asset-based’ or ‘strength-based’ approaches: • Look for people’s gifts, skills and resources first, rather than their needs, vulnerability, diagnosis. • Refuse assumptions about people’s potential. • See people and communities as experts: co-production. • See connectedness to family & community as crucial So not just the same old gift-model professional/client transactions in new locations or with new budgets. He’s just one of the family. I get as much out of it as he does.

11. TheWhite Paper and draft Bill • social care from crisis-only to well-being system • duty on councils to develop preventative services • information, advice and decision making support • family carers are recognised in law for the first time • community contributions and active citizens • move away from medical models of care & assessment • promotion of time banking, Shared Lives, micro-enterprises, Tyze care networks, Local Area Coordination Care and support will … focus on people’s skills and talents, helping them to develop and maintain connections to friends and family. Communities will be encouraged and supported to reach out to those at risk of isolation.

12. Ways forward • Focus on supply as well as demand. • From consultation to genuine co-production. • From informed consumers to citizen-led commissioning. • Communities in the lead, not just ‘community-based’. • Underpinned by a strengths-based approach. Does this add up to a genuine culture change? Are professionals ready to give up power and take risks?

13. Diversifying supply: micro-enterprises • Local people working with/ for other local people • Work on a very small scale (5 or fewer people) • Community Catalysts helps councils create micro-friendly conditions. Shared Lives Plus supports 140 members. Pulp Friction DanceSyndrome Ace of Spades

14. Ways forward: • citizen ownership & leadership • Co-production is often influencing someone else’ service – increasing numbers of people want (shared) ownership and responsibility for making a contribution. • Not just User-Led Organisations (ULOs) but citizen-delivered services and interventions • eg Service user, family and citizen led commissioning. • egStamford Forum/ Leeds Council neighbourhood network model, pooling individual, council and community resources with social finance investment.

15. Ways forward: • family and community • The ‘unfinished revolution’ (CSJ): communities must be involved, not just ‘community-based’ traditional services. • Professionals need to share power and risks fairly, openly. For instance: • Shared Lives: registered Shared Lives carers involving family, friends and neighbours in support. • KeyRing: a community-based volunteer who helps people to form and link up networks of support.

16. Ways forward: • strengths-based approaches • A conversation about living a good life which looks at many different routes, with services last on the list. • Professionals and individuals recognise the limitations of services when it comes to achieving a good life. • egLocal Area Coordination (LAC) • egAsset Based Community Development (ABCD)

17. Finding abundance in austerity • Public money is scarce. • Informal support can be abundantbut… • informal support is not always spontaneous. • Community is not a place, it’s a set of relationships.

18. Questions for discussion • How do services help people build their relationships? • …and avoid undermining or displacing real relationships? • Where do children and families services already take a strengths-based approach, and where could they do so? • What could the children and families sector learn from both the successes and limitations of personalisation? • What could adult social care learn from the children and families sector? • Self-directed support • Personal budget control • Community development • Co-production, ULOs

19. Contact details Alex Fox, CEO, Shared Lives Plus, alex@SharedLivesPlus.org.uk www.SharedLivesPlus.org.uk; http://alexfoxblog.wordpress.com Twitter: @alexsharedlives Personalisation: lessons from social care, RSA: http://goo.gl/QSlDg. Redesigning the front end of social care: http://goo.gl/dcxzh. West Wales Adult Placement