Tuesday, 19 November 2013

Why social care has to go beyond needs

For the past generation, Western Australia has been pioneering a different way of organising social care.

It was the brainchild of their new mental health commissioner Eddie Bartnik, and it flew in the face of conventional methods, which assess needs and try to slot people into existing service packages.

What he came up with instead was not just more flexible and more human, it was also less expensive. It was and is called Local Area Co-ordination.

LAC is now working here too, notably in Middlesborough and Derby, and it is run by a group of local area co-ordinators who are the very opposite of specialists. They are more like coaches than social workers, and they start somewhere different.

Rather than asking immediately about needs, they ask what their client wants to achieve in their life – then move on to the personal and social assets at their disposal.

Then they try to see if what they need can be provided informally, from friends or family, or neighbours – it might be regular lifts or other kinds of regular visits.

If the informal approach doesn’t work, then they fall back on conventional care packages. It is the reverse of the usual approach which starts with the care packages, and only if people complain very loudly do they fall back on informal solutions.

The spirit of LAC is the cornerstone of the new Care Bill, thanks to the efforts of people like former social care minister Paul Burstow and Alex Fox of Shared Lives - but still the Care Bill doesn't exactly roll it out. Now Eddie Bartnik himself has been over and I was fascinated to see Alex Fox’s description of his visit.

Of course, I subscribe to the vital importance of a flexible interface with the public, rather than what we currently have.  I absolutely agree that LAC makes possible friendship, love and permanent social assets.  I can see why it was so much more popular in Western Australia (though not in Scotland, but that's another story - about trying to shift unwilling professionals).

But what I really took in from what Bartnik said was this:

"You won’t understand and meet people’s needs, if their needs are all you are interested in."

That is absolutely right, and the way the system has undermined any of the assets that people have except their needs - their only passport to any kind of help - explains some of the way that it tends to maximise needs.  Of course it does, if that's the only thing people have left.

My own feeling is that LAC ought to be in place everywhere.  But like so many of these other innovations, under the broad heading of 'co-production', you find you need a different kind of professional altogether to run them.

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