by Ralph Broad (Director Inclusive Neighbourhoods) and Cormac Russell (Director Nurture Development)
We are now at the crossroads in social care and health services and also in our local communities.
A “crossroad” presents us with a set of questions. Here are some of the interrelated questions that are exercising us:
- Is Personalisation dead?
- Can Personalisation and Personal Budgets solve all our social care problems?
- Do we continue to just cut services and tighten eligibility, risking increasing crises, dependency, unmet need and exclusion in our local communities?
- Do we further complicate the system by just adding new, often disconnected, service initiatives but keep the system and balance of power the same?
- Do we continue to tinker with existing professional roles, adding in new responsibilities and often making the roles (and service system) more complicated, less focused, less satisfying (for professionals involved) and moving them away from their original principles and vision?
We believe the answer to each is “no”
Having answered accordingly, some high level solutions present even before we go down one pathway or another:
- Don’t wait for people to fall into crisis
- Don’t judge or label local people and local communities on perceived deficits
- Work together to recognise and nurture their gifts, skills, passion and aspirations
- Support people to develop their own personal vision for a good life and the range of ways they can get there.
- Maximise the effectiveness and value of specialist services as aback up to local, practical (non service) solutions and connect people who need resources or services more quickly and simply
Over many years, the health and social care system in Britain has become very fragmented and difficult to navigate (for both people/families and professionals) and has focused predominantly on deficits of local people, defining people by what they can’t do, and applying services or money for solutions to those deficits. This has created a dependency culture, with people viewed as “clients”, “service users” or “customers” of a social care system and often negatively labelled as passive recipients of social care funding or services; and accordingly viewing themselves as supplicant.
Local Area Coordination (LAC) and Asset Based Community Development (ABCD) are two approaches developing in the UK aimed at paving a clear path for citizens and policy makers away from “clientelism” and towards active citizenship. In practice, both approaches aim to nurture individual, family and community strengths to build stronger, more welcoming and more inclusive communities and, in a broader ideological sense, supporting the re imagining of social care and health services
Local Area Co-ordination (LAC) was originally developed in Western Australia in 1988 by Eddie Bartnik and the Disability Services Commission, with assumptions and beliefs around the inherent expertise and strengths of people, irrespective of service labels, to plan, control and contribute to their own lives and the well being of their community. It also acted as a catalyst for service and systems reform, making services more personal, flexible, accountable and efficient, nurturing practical, local solutions as the “primary source of support” and pushing services back a level. It has subsequently been developed across Australia and internationally, including sites now developing in England and conversations underway in Wales as part of social care and health reform.
The Asset-Based Community Development Institute (ABCD), was established in 1995 by the Community Development Program at Northwestern University’s Institute for Policy Research, is built upon three decades of community development research by Professors Jody Kretzmann and John L. McKnight.
The mutualisation of both approaches is now well advanced under the guidance of the authors of this blog. Building on long term, evidence based and innovative frameworks, these innovative approaches to supporting local citizens and communities to build and pursue their vision for a strong, mutually supportive community offer tangible answers to the five questions at the beginning of this piece. The combination balances the need to “come alongside” people who are vulnerable through age, frailty, disability or mental health issues to achieve their vision for a good life, with a community building approach which increase the competency of the wider community to co create healthier, more prosperous and hospitable communities
This maximises the opportunity for those who are most vulnerable to stay strong, use and share their personal strengths, maintain good health and personal relationships, to support people to be part of, and contribute to, their communities and to strengthen the capacity of communities to welcome and include people. At the same time, communities are identifying, connecting and mobilising their collective assets for the well-being of all members of the community, inclusive of those on the margins.
This combined offer presents as a powerful catalyst for service and systems reform, forming the new “front end” of the service system, moving the focus from assessment, funding and services to prevention, community building and local solutions, with formal services and specialist roles moving back as a “back up” to local solutions (as per “A Vision for Adult Social Care, DH, 2011).
Making it Real: Operationalising the Vision
Local Area Coordination is underpinned by 10 Core Principles and these are delivered and support by the Local Area Coordination Framework. These principles underline
- The right to citizenship, responsibilities and opportunities
- The importance of valued relationships and personal networks
- The importance of access to relevant, timely and accessible information to inform decision making
- Recognising and nurturing individual, family and community gifts and assets
- Recognising the natural expertise and leadership people labelled as vulnerable and their families
- The right to plan, choose and control supports and resources
- The value and complementary nature of formal services as a back up to natural supports and practical solutions
The LAC Framework supports the design, development, implementation and accountability/outcomes of Local Area Coordination. See “From Service Users to Citizens” (due late April 2012) or contact Inclusive Neighbourhoods for more information or support.
Short Cuts Don’t Work – A Real Opportunity to Reform Not Tinker
Local Area Coordination is NOT about adding a few tasks on to existing social work roles or just a variation on community based social work.
It (LAC) becomes the new “front end” of ths service system, pushing formal services back a level, connecting service and age types and focusing on people, families, communities.
It provides the context for re thinking the roles and desired outcomes of specialist and funded services, with an intentional preventative approach at the front end, nurturing local community resources as the primary source of support.
It focuses on assets, strengthening individuals/families/communities, practical (non service) solutions, with social work and other specialist services as robust, focused, valued back up services.
It is very different from, but works in partnership with, social work and statutory functions
Opportunities for Wider Reform
LAC and ABCD also provide the opportunity for all professionals to think about identifying, connecting and mobilising individual, family and community strengths as an important part of their roles in supporting people to stay strong or solve problems.
As a “cradle to grave” approach, embedded in local communities and developing lasting relationships with local people, it also provides the opportunity to simplify the service system for local people (a genuine single, local, accessible point of contact in the local community – across service types) and connecting/integrating service types.
The challenge is to make sure that “salami slicing” of services to save money is not the only approach and that any new initiatives don’t further complicate the system, have an evidence base and sound methodology for inclusion, non service solutions, strengthening communities and contribute to reforming existing services. Merely cutting services, without attention and investment in alternatives, substantially increases the risks of further isolation, exclusion, crises and people becoming more vulnerable. It will place further pressure on services that are already struggling to cope – an accident waiting to happen
Local Area Coordination/Asset Based Community Development and reform will require positive values and assumptions about local citizens and communities, long term commitment, leadership and vision, with real contribution and partnership with local people. A significant portion of this reform will require a sea change in attitude among managerial classes about the unique competencies of communities in the areas of health, safety, care for the environment, safe food production and consumption, local economic development, ageing well in a place/locale, building strong communities, civic action towards deeper democracy and a more just society, response to emergencies and co-producing knowledge and the limitations of system based responses in those domains
Local Area Coordination and Asset Based Community Development are about starting conversations and building connections.
They are about
- keeping communities strong so that they are competent enough as active citizens to sustain and keep each other strong
- having positive values and assumptions about people labelled as vulnerable and our local communities.
- people coming together – mutual support
- social justice
- building strong, welcoming and inclusive communities
- acknowledging and supporting the value of services and money, when delivered at the right time, in the right place and for the right reasons – as a back up to local natural solutions
It’s about more than services, money and negative labels.
Providing better ambulances at the bottom of the cliff instead of fences at the top is a half-baked and wasteful endeavour for policy makers and practitioners alike. This reflection piece, therefore, concerned itself with the means by which, with labelled people in the lead, families, communities and agencies can co-create better fences before the precipice, and ensure that a good life is nurtured well before people reach the “edge”. To ensure people can seek a life of their own choosing, we assert that a combined LAC/ABCD approach will prove more fruitful than current isolated deficit based approaches, exclusively concerned as they are, with the needs and problems of an increasingly growing vulnerable population.
A good life, across the life-course, in one’s own place, in a way that feels productive, surrounded by family, friends and neighbours, is everyone’s business and is worthy of greater attention than is currently being afforded to this simple, powerful ambition. The central crisis of modern health and social care system is our neglect of the task of building hospitable, competent communities where everyone can contribute their talents, skills and knowledge, while receiving the contributions of others in kind.
And so, in the final analysis we are faced with one fundamental question:
“Do we support communities and local people to build and pursue their personal and community vision and simplify services and systems to make them more personal, relevant, flexible, facilitative and accountable, or continue to tinker at the edges and adjust existing roles and services?”
The answer will define all our futures; policy makers would do well to realise they will live long enough and across the life course be at one point or another vulnerable enough to inherit the legacy of their decision: Do we tinker or reform?
LAC Network Newsletter Issue 1 out now – download here