Friday 31 May 2013

The future of public services isn't sharing info - it's upside down

One of the most inspiring visits I made for the government's Barriers to Choice Review last year was to Middlesborough, to meet people involved in the new Local Area Co-ordination scheme there.

Perhaps it isn't the most impressive name to use for something that has turned social care upside down in Western Australia, but it manages to combine higher support from care users and lower costs - which isn't unique, but is a sign that something important is going on.

LAC started in Western Australia in 1988, thanks to the social services director Eddie Bartnik. It is now used to support social care in other Australian states and has been successfully adopted in Scotland, Ireland, New Zealand, Canada and now England, starting in Middlesborough and Derby, as an approach to early intervention and prevention.

LACs are generalists who support practical, creative and informal ways of meeting people’s aspirations and needs, increasing the control and range of choices for individuals, their carers and families.  Their activities focus on supporting vulnerable people to build a vision for a good life that is individual to them, and to build the family, relationship and community networks that make it possible. 

LAC operates at individual, family and community levels and can help individuals, their carers and families to plan, select and receive a range of support and services to achieve their vision for a good life, enormously increasing the flexibility of services and providing users with much broader choices.

What is fascinating about LAC is that it is absolutely cross-service.  The first point of contact is someone who will focus - not on your needs - but on what you want to achieve, what informal support you might need to get there, who they know who might help.  Then they will coach you to a position where you are much more active in your own life.  Only if that fails, do they fall back on the traditional care support packages.

I was interested then because I had suspected for some time that there is a new kind of profession emerging in public services, which has many of those characteristics - asset-based, as they say in the jargon, cross-departmental, starting from where each individual is in their life at the time.

I mention this because I read a post yesterday from the very energetic thinkers in the iNetwork in the north west about the health and well-being 'timebomb', which also linked me to the ambitious joint statement by almost everyone in the health and social care field about integrated care.

I would disagree with nothing in either of these, but the success of Local Area Co-ordination seems to me to point in a different direction.  Not one that is basically about 'joint working', 'sharing information', 'co-ordinated care' or any of those phrases which imply that this is basically an information and co-ordination problem.

I don't believe that a social care system which now sends seven agencies to your front door can survive - and I don't believe it can survive, even if they share information seamlessly between them.

What Eddie Bartnik, and his UK vicar-on-earth Ralph Broad, have developed is the beginnings of a different kind of system altogether, which starts from hopes not needs, and which has a multi-disciplinary, semi-informal human face at the front of it.  Local Area Co-ordinators can still fall back on professionals if they need to, but often they don't need to.

The Barriers to Choice Review taught me that that sheer inflexibility of the current system, the multiplicity of agencies, must make way for something much more flexible - and I suspect that means the following:

1.  Turning services upside down so that informal solutions and social support is the first resort, not the last.

2.  Merging public services together locally, schools, health, social care, housing, and so on.

3.  Turning those hubs into catalysts for an enormous increase in local involvement and mutual support (co-production).

4.  Concentrating resources at the intractable problems, the small number of people and families who both slip through the cracks of the current system and involve most of the costs.

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