News and Comment

Greater demand for personalisation necessitates further changes in supply

Monday 24 June 2013

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A new Respublica Green Paper by Alex Fox argues that the personalisation agenda must go further than simply enabling personal budget holders to choose between the limited range of supports that exist. The supply side, it says, must also change. The constraints on the current industrial scale provision of care homes and domiciliary care mean that whilst they are able to meet the physical care needs of older people they many of them as, if not more, isolated and lonely as before.

The report points to Joseph Rowntree Foundation research which says that older people aspire to living the ‘good life’ rather than managing their decline. Critically this includes: keeping up existing, and building new, relationships; being able to help others as well as receive support; and living in appropriate housing. Given this, we need new human scale, micro-approaches that enable older people to be part of their local communities and build on their strengths whilst meeting their needs. These approaches also enable a much wider range of informal and professional relationships to work alongside and enhance one another in a ‘networked’ model of care.

Fox shows that thanks to the work of Shared Lives (where he is also CEO) and other organisations new forms of housing and support are already emerging. Shared Lives matches older people to families with whom they can either live full time or during the day. Micro social enterprises, formed by domiciliary care workers enable them to provide personalised care at a pace and scale that puts relationships first, links the older people they care for into their communities and also delivers the personal and other care that is required. Leeds Council, supported by the Stamford Forum, has enabled old people to pool personal budgets to buy new types of services that reduce isolation and build mutually supportive friendships. Hanover Housing is working with local people to set up an inter-generational co housing cooperatives that are designed to actively enable community support between residents. In the Isle of Wight, Care4Care is a timebank which enables more able older people to care for other older people who require support. The ‘hours of support’ that they contribute can then be drawn on by the current carers when they in turn require support in the future.

The Paper points out that whilst knowledge of these and other micro developments is becoming more widespread, they are still seen as interesting but essentially niche adjuncts to the mainstream housing and care industry.  The big issue for interested commissioners is how to commission the large volumes of services that would be required if these new approaches were to replace existing domiciliary and residential care. Respublica put forward a commissioning approach that focuses on market shaping rather than block commissioning. They envisage the franchising of models of care, such as those developed by Shared Lives and Community Catalysts, to support local micro developments. The franchise would provide a basic specification for the service that can be ‘scaled out’ through supporting local based service development, a regulated rather than a tightly specified ‘scaling up’ approach to franchising.

Alongside changes in local commissioning Fox proposes provider developments including redesign of services to blur the boundaries between formal/informal, paid/unpaid. An example of this is the way that Community Catalysts was invited by the care provider MacIntyre to work with its staff to encourage them to develop its services by acting creatively and with autonomy at the micro-level. Nationally, the Care and Support Bill regulations should include market shaping to support micro services development and the Department of Health should remove the existing barriers to commissioning these types of service. The role of mutuals in providing the new services should be supported by the Cabinet Office’s Mutuals Task Force and by making creative use of the provisions of the Public Services (Social Value) Act.

The approach that Respublica advocate fits well with that of the National Collaboration for Integrated Care and Support that aims to make integrated care both person-centred and asset-based. However if these aims are to be met complementary changes must be made which also build the principles and practice of coproduction into existing core services in both health and social care.