The right thing to do is also the economically sound thing to do

Mike Richardson explains why the recent report demonstrates a forest of impact, rather than just green shoots of hope, for strength-based practice in Adult Social Care.

About a month ago, I looked at the national data for all local authorities from across England, with a view to identifying the impact of a particular set of strength-based principles and behaviours, as laid out in community led support (CLS) on adult social care. The 6 impacts that we’ve chosen in our report are the ones where not only can we see a marked difference to the national data trends , but ones where we see them strong connections to the strength-based behaviours and principles of CLS.

We know that nothing happens in isolation, but with these particular 6 impacts, we know the sites that have engaged strongly with CLS have also deliberately explored other strength-based practices, which together increase the ability to support the community. We know that CLS works really well in driving these trends, but we are also aware that this approach works best when applied in areas where investments in community assets have been made, and staff are empowered to operate outside the bureaucracy of care management processes. It is also enhanced in places that have a system wide approach to supporting people to achieve their outcomes, areas where they may have used local area coordination, social prescribing, and community catalysts as part of that response too. In short, we believe that these are the result of strong leadership and a commitment to strength-based approaches over time by these areas.

I often use an analogy that membership to CLS is like membership to a gym, signing up alone does nothing for your weight or wellbeing – your intended outcomes - it only works if you do the work. Only then will you see those changes. These changes are the result of a concerted effort and approach.

This report is very numbers based and doesn’t hold a lot of information about the practice that drives these differences, but these numbers are showing the impact of quality principled behaviours. The quality and the engagement of the strength -based practice is of overriding importance - just meeting people early without bureaucracy has minimal value. Meeting people with the right skills in the right way with the right conversation with an intent to do the right thing. That’s what works.

In these times of limited resources, strength-based practice is often seen as a nice thing to do, and for some perhaps a luxury they can ill afford, in that respect I think it's really important to show the hard data that demonstrates that it's also a hugely effective thing to do, and in fact it's the economically sound thing to do.

This report shows that if through quality strength base and person centred ways you are able reach out to people and meet them before the crises, you may need to do more in the first instance than traditional assessments and eligibility, but overall that additional work is effective and preventive: it does more good and in the end you spend a lot less.

The green shoots of hope around doing the right thing are becoming a full forest of examples of good strength-based practice. Not only are we seeing more people dealt with in a good way, but we’re also seeing indicators of quality of life and choice and control. Do it quicker. Avoid the crisis. And also give people skills so they can avoid the crises themselves. We should never leave someone in a situation that is avoidable because it's morally almost reprehensible and economically foolish.

I believe this report shows that by using CLS and strength based approaches, these areas are working in a way that gives people choice and dignity about how they are supported and how they connect with that, rather than (inadvertently) waiting for people to become eligible for care as post crisis support. As a result, I don’t think it’s a surprise that the data shows people feel they have a better quality of life compared to the national benchmark.

The report also shows that people value that control and gaining understanding of the packages of support. We know from feedback in the network that people who are seen quicker are both able and willing to make use of informal support and don’t insist on the maximum support available. We believe this is because they’ve not had to wait for what can sometimes be months and go through some long winded eligibility assessment of what’s wrong so they can get to much needed support of any kind and desperate to accept what is offered. We believe responsive sensitive conversations about all options mean people are opting to say, you know what? Maybe I'll go away and I'll try these things and if they don’t work I know I can come back because I know I can get back in quickly to talk it over with someone.

Obviously, this is pre COVID data. And the new data analysis, which we’ll be working on very soon, will in all likelihood show that the pandemic, along with its terrible human consequences, will have created all kinds of difficulties and changes in behaviour in the system. These might be seen in areas as diverse as people opting out or shunning all forms of much needed care, the inability to engage with people face to face to avoid crises, the effect of shutdown on communities and businesses and the resultant impacts of these on people’s health and wellbeing which will eventually spring back and cause issues for our health and social care system as a whole.

That said, there is anecdotal evidence that places with strong community networks have been in a better position to weather this storm. Sites within the CLS network have been sharing stories about how local authorities and health systems and practice have worked to build resilience to keep people in control, and I am hopeful that future data will show the value of this in what has been for everyone the most challenging of times.

In this report I would have hopedto see a greater impact on outcomes for unpaid carers, and while that's not a focus initially of CLS, but there's no reason why it couldn't be, so there is scope for the values and principles of this way of working to impact there too in the future. The difficulties felt across all parts of society now are brutal for everyone, but it can be carers who feel that have that kind of impact exponentially - there's a multiplier involved: as they feel the challenges of caring for themselves as well as a loved one, they shoulder more of the burden of their emotional and physical support in these times of crises. The conversations that we have in CLS could definitely be better at supporting and heading off the potential crisis that looms down the road for carers. It continues to go unseen, but the data that sits behind this report shows that it is likely to cause difficulties later with very human consequences.

The big learning from this report for adult social care is that being responsive to that initial cry for help is a very quick win. It is the right thing to do, it is the wise thing to do. If intelligence can be defined as the capacity to create capacity, an intelligent organisation is the one that uses its limited resource now to save the bigger use of resource later. The slower burn impacts will be the impact on the health system and other partners and the impact on the use of care, and ultimately in the types of care we use and the value we get from these as a being responsive and person centred will require a re-think not only in when we work together, but how and why we work together. That has to be better for everyone.