Good lives at every stage – reflections from our recent roundtable

In a recent online roundtable, colleagues that work within use and lead adult social care emphasised the need to treat each person as an individual and plan for  a ‘good life’ for them. However, achieving this within systems and roles which require us to work with large numbers of people, often with limited time and options, presents a significant challenge. This was articulated well by two participants:

“There’s not always a lot of aspiration for children and young people with additional needs. The education system’s assumptions about my son were all about what he couldn’t do, not what he could. That lack of aspiration impacts on families’ aspirations too, so we need to change the language at an early point.”

“There are thousands of pieces of paper for an individual, but the changes are not always happening. We have the evidence and know what good preparation for adulthood looks like, but we need to be able to keep it simple and make it happen.”

Bridging the gap between individual practice and system-wide change is at the heart of the challenge, particularly amidst increasing demand and costs, and shrinking resources and workforces. It requires a combination of place-level activity and individual-level behaviour change interventions.

At IMPOWER, we produce a clear picture of what an area is currently commissioning and where those metrics are heading. We also do a deep dive with practitioners to build a whole-person and whole-household picture of people’s strengths, needs and goals, and how their current support package from services, or from family carers, matches what they want and need. At individual level, this prompts reflective practice about what is possible.

Participants stressed the importance of a ‘rights-based’ approach to understanding individuals’ needs and desires. There was scepticism about the unclear and overuse of terms like ‘strengths-based’, and the tendency of new jargon and new bureaucracies to spring up. The impact of that cannot be underestimated:

“Families will try to use your language and their children will too, because we are trying to fit into your system. We will only ask for what we think is available, so enabling families to ask for what they need is complicated, because we don’t know what’s possible.” (Family member participant).

There was also scepticism that training alone can change practice, which is constrained by bureaucratic case management systems, hierarchies, and statutory requirements. So, what can create change?

Adult social care practice frameworks tell us to do roughly the same thing, but there is a gap when it comes to how to do it. Rights and outcomes-based practice breaks down when what’s needed simply isn’t there: “we put a round peg in a square hole, even though we know it’s wrong, because we’re doing the best we can with what’s available to us.” So, IMPOWER has developed an approach that could present a rounded picture of each individual: physical and practical support needs; community participation; goals around work, education and training; relationships that are important to them; independence; safety; and, whether they are living in place that feels like home.

The approach has prompted reflective conversations and lightbulb moments. Care packages are sometimes constructed around one particular risk at the expense of areas of life that may be the most important to the individual and their family. The ability to aggregate data into a whole-cohort or whole-area view of what is being offered, used and valued, and where the gaps are, enables commissioners to have evidence-based, strategic conversations with existing and prospective provider organisations. It also enables them to model where resources can be shifted – from sectors which are over-used and under-achieving, to those which are the best fit for the changing aspirations of local people.

We recognise this is not simple. At the roundtable we discussed how introducing approaches which try to capture information systematically risks systematising people. The chair, Martin Samuels, Lincolnshire’s Executive Director of Adult Care and Community Wellbeing, discussed how our systems like stasis, but the most important moments in our lives – for better or worse – are often moments of change. That change in our lives is often gradual, and can be messy, whereas changes which are made for us by systems are often sudden, and all or nothing.

We are not underestimating the challenge of trying to bridge between those two worlds, but one thing that we all agreed on is that change is needed. Despite so many people who use and who offer support pouring their hearts into achieving the best possible outcomes, our current systems are not yet consistently creating what Tricia Nicoll (consultant and a convenor of Social Care Future with experience of both drawing on and shaping social care) describes as ‘Gloriously Ordinary Lives’.

If you are in an area which might be interested in co-producing our new Valuing Good Lives approach as part of a small group of pioneering councils, please get in touch.