Lancashire's plan to avoid providing 'too much care' - and help people keep their independence
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That was the message from Lancashire County Council’s cabinet member for adult services as he set out the authority’s vision for how it provides care to vulnerable residents, which focuses on how people can maintain their independence and regain it when it has been lost.
County Cllr Graham Gooch says that it is important for those making decisions about the support on offer to individuals who need it that it makes their lives better - and does not make assumptions about how they would like to be helped.
“Historically in Lancashire, we’ve put far more people into residential care than any other county and given people bigger care packages than practically [anywhere] else. But we’ve never been sure if it’s what people actually want or not.
“We want more independence and reablement for people - not just to go along with a basket of services, saying, ‘We’ll give you this [or] that - take it or leave it.’”
The county’s newly-revised strategy for caring for adults in need of support aims to avoid offering “so much help that people lose their confidence and become dependent on support arrangements, which could limit their lives”.
The document also recognises what the county council says is a reality - that most people want to stay in their own homes whenever that is possible, rather than moving into residential care.
While the strategy often focuses on the help that people may need as they age, the principles underpinning it apply to the many younger individuals requiring support as a result of disabilities or special needs.
The shift towards promoting independence is one which Lancashire resident Micky welcomes - after a decade of needing care from the county council.
Back in 2011, then 26-year-old suffered a serious brain injury after a motorbike crash and, for several years, received round-the-clock support in his own home. His care package is now down to around 50 hours per week - and while he appreciates the care he continues to receive, he enjoys having more time to himself.
“It was weird having some stranger in my living room, sat on my couch, making my brews,” Micky recalls.
As part of the help he is currently receiving, support workers have focused on enabling him to do the things he enjoys - including metal detecting and going to the gym, as well as the most important part of his life: “Being the best dad that I can be.”
For social worker Nigel Rainford, the support he wants to provide Micky is about enabling him to live - and not just exist. To that end, he is trying to help him achieve an ambition of giving talks to people who face similar challenges to those that have beset him since his accident - and those charged with helping them.
“I think he’ll be able to explain the problems he has experienced with his disability - and other people would benefit from hearing about it. [As] social workers, we need to know real people and real people’s lives - and [hearing from] somebody who is keen to talk about what his disability means would be great.
“I think he is looking at this public speaking role as a way to develop more. It’s always a work in progress [for people in Micky’s situation] - we can’t just rest on our laurels and look at what’s being provided, we have to look at how he is progressing,” says Nigel, who next wants to focus on improving Micky’s IT skills.
Micky himself recognises that his own mindset has to match the efforts people are making on his behalf if he is to achieve his aims in life.
“Some people give up, roll over and think, ‘Why me?’
“I’m not [like that], I say, ‘Bring it’. I might be disabled, but if you say I can’t do [something], I’ll do it - I’ve got a positive attitude.”
County Cllr Gooch acknowledges that an individual’s outlook on life - and the degree of independence they can achieve - will depend on the personal challenges and circumstances they face. However, he is convinced of the dangers of pigeon-holing people and so limiting what may be possible for them.
Pressed on whether the new strategy amounts to a cut in services, he says that it would be a mischaracterisation to present it in that way - but acknowledges that its aim is to lessen the support that people ultimately require.
“To a certain extent some services will be reduced, but not those that are necessary - because it will be [about] what the person wants and needs.
“You can give too much - you could have somebody sitting at the end of your bed for 24 hours a day, but [people] don't want it.
The new adult support strategy states that “expectations are changing” when it comes to the care people expect - and suggests that the pandemic has increased the demand for good quality "personalised” care, closer to home. It indicates that such care is often better provided by organisations other than the county council.
The authority has also developed a so-called “three conversations” approach to determining how best to help people.
“The first is to ask, “How can I connect you to things that help you get on with your life?’ - based on their strengths and those of their family and local community, to see if they can all work together,” County Cllr Gooch explains.
“Conversation two is about what needs to change to make [someone] safe - and what the social worker has got at their disposal, including small amounts of money [to achieve that]. So instead of having to send everything up to a panel for sending [decisions], they’re allowed to spend a certain amount of money themselves - they’re professional people, so let them use their judgement to do things that they can do straight away.
“Finally, we ask what is a fair personal budget that [a person] will need and where the sources of funding come from - and to consider for them what a good life looks like.”
The strategy also emphasises the role that technology can now play in keeping people safe and well-supported at home.
County Cllr Gooch says services need to recognise that the people who are now in their 80s have lived through different technological and social eras than those who reached that age decades ago.
“I visited a care home before the pandemic and the residents were sitting around and having a sing-along to the old Vera Lyn stuff and I said, ‘Hang on, when these people were growing up, rock and roll was what was playing.’”
“And people in general do what to stay in their own homes. Some of the pressure comes from relatives - they feel safer [if their family member moves into residential care] - but the actual service user [doesn’t] want to go into a home.”