Authorities need to consider how to make better use of community resources
Rosemary Trustam reports on the 22nd National Adults Commissioning and Contracting Conference 2014.
Investment in a Neighbourhood Network Scheme (NNS) could be seen as ‘off message’ in an era of personalisation, said Mick Ward, Head of Adult Commissioning for Leeds City Council. Instead of direct payments, they top-sliced their adult social care budget to give £2 million to a third party for the NNS’s core costs. They also gave them a five year contract (with optional three year extension) from 2010, recognising the need for a longer-term investment. By March 2014, their investment in the 37 neighbourhood networks, each run by and for local older people, was supporting more than 21,900 older people with 1,900 local volunteers.
Monitoring outcomes
By monitoring outcomes they prevented 1,450 older people from going into hospital and supported 617 people discharged from hospital in the last year. As part of their monitoring an individual story is cited every month. One was of a 61-year old woman with a history of mental health problems who had been to A&E seven times and admitted twice. She was found wandering in her nightdress and services didn’t identify the problem until a volunteer visitor went to make her a cuppa and saw three cases of Red Bull – she’d been drinking 12 a day.
With less money, Leeds is trying to focus on what should be spent for the greatest impact. For example, they’re looking at the role of their sports and leisure centres in services for people with learning disabilities and older people.
A major aim is to tackle loneliness and isolation. This, said Mick, is a bigger killer than smoking 15 cigarettes a day. Research by the Joseph Rowntree Trust found a significant adverse impact on communities which directly influences care and health.
Community brokerage
To combat the problem, Leeds recently added a further £300,000 to the contract value to expand opportunities for community brokerage, day opportunities, social prescribing and innovative ideas. They know their people and where they are, so using all their sources of information, ‘street champions’ go door-knocking. Their community brokerage uses a community connecting model finding local links and building from individuals. Examples include an ex-parks worker who was a whittler whose group finds tree branches and whittles walking sticks which they give to a day centre; a Harehills woman whose poetry group reads in their language; a pub landlord who spots older men on their own, chats to them to learn about them and then links people up.
They have a small sparks fund offering grants of a few hundred pounds but 70 per cent of the people don’t use them and end users don’t know they are part of a project. Examples which have used the funds included a workers’ cooperative delivering home care in the Asian community; an Asian cookery group; and a handy man service.
Leeds’ community development has volunteering at its heart. Everyone gains, whether through access to the community training programme or through time banks, peer support or the discovery of skills in the people who are helped as well as the helpers; for example, the ex-farm labourer developing dementia who discovered he could paint from going to art appreciation in an art gallery.
Specific initiatives
Their initiatives have also brought in resources from the Big Lottery Fulfilling Lives fund to spread ideas across the city. Leeds is a member of the WHO Global age-friendly cities network and is developing specific initiatives with business; for example, their 12 top retailers are looking at making loos more accessible and creating dementia friendly retail environments; the parks department is reviewing their strategy; arts and cultural commissioning is being geared to help social participation; for example, the Northern Ballet has ballet classes for people with dementia and Yorkshire Dance line dancing and the Yorkshire Playhouse is putting on its first dementia-friendly performance in November. At the end of October they held an older people’s conference exploring the contribution of older workers for employers.
There’s been some small funding to stimulate ideas that change lives; among many examples, instead of providing care to individuals, someone set up a cookery course to include some of them; they paid someone to teach a group of people with learning disabilities how to set up a band.
Unintended consequence
Leeds‘ work challenges our ideas of personalisation with its limiting notion of carefully measured individual entitlements to ensure delivery is made only to that person. The move away from ‘block contracts’ to personalisation is seen as promoting creativity and more tailored services to the individual. However, it has perhaps had the unintended consequence of separating people’s support and limiting the creativity that can come from sharing solutions. For example, in the face of tightening resources and the need to save money, we’ve seen some local authorities invest in review teams whose raison d’etre appears to have been to cut individual packages. Leeds is showing that savings might have been generated by better regular reviews and investment in communities and innovation.
Now we are beginning to see service user or provider generated ideas of pooling personal budget resources to share support for social occasions (and to stay up late!) or to fund a shared session or group activity. Local authorities need to consider whether their notion of the use of ordinary community facilities and activities by people funded by their personal budget might need a more strategic approach. Couldn’t they make better use of limited resources and review the balance of their individual and population commissioning?
A full report of this conference is available on our website: www.cl-initiatives.co.uk
