Rosemary Trustam reports from a conference of commissioners entitled Successful pathways towards integration – building resilience in a changing world where a key message was that specifying outcomes is unlikely to lead to better commissioning.
When wolves were reintroduced into Yellowstone National Park regenerated forest areas were avoided by deer, rivers changed due to less erosion, and populations of birds and beavers increased. Conference chair Alex Crawford, from Aneurin Bevan University Health Board, said if these outcomes had been specified it is doubtful anyone would have suggested bringing in wolves to achieve them!
He was underlining a key message of this conference on integration, that specifying outcomes in such a complex world is unlikely to lead to better commissioning. Building on this, several conference speakers also emphasised the importance of building trust and relationships across services, between providers, commissioners, communities and, most importantly, by listening and handing influence to people and families.
The conference challenge was how to connect the different parts of health, social care and housing to be there when people most needed them. With mounting cost pressures for adults with disabilities, the importance of partnership was stressed. The key elements of partnership are building trust, relationships, common purpose, and mutual respect, modelled from the top. A coordinating lead is needed for integration – ‘a choirmaster so everyone sings the same tune’. It also requires organisations to get the relationship structures right, share risks and respond jointly when things go wrong. Proper resourcing and government understanding of the need for joint approaches to serve the same people are also vital.
Conference presentation highlights included:
Toby Lowe, Senior Research Assistant from Newcastle University: his research evidence challenges outcomes-based contracting approaches. He argues that these encourage people to produce good-looking data rather than meet client need, and therefore fail to produce good outcomes. Practices such as ‘creaming’ results where, for example, work programmes only concentrate on those most likely to get a job and ‘park’ those who present the biggest challenge. Commissioners need to develop healthy network systems based on trust and positive relationships with and among providers.
Mark Saunders of Greater Gwent’s Health Social Care and Wellbeing Transformation Support Programme described how a residential abuse scandal led them to review their monitoring to find more innovative ways to get feedback. Volunteers from an NHS retirement group have confidential discussions with people and relatives following My Home Life Cymru standards. Tanya Strange gave an inspiring presentation about Primary Care’s numerous community connecting activities aimed at tackling loneliness, including a website (www.ffrindimi.co.uk) to provide a single point of contact for self-referral, volunteers matched with lonely people according to their interests, and a staff volunteering scheme. Other plans include community recruitment to train volunteers to look out for and protect people.
Advonet with Leeds City’s ‘Good Lives Leaders’ (GLL’s) project developed a contract monitoring system using people with learning disabilities and family carers as quality checkers. Built through a consultative design process the project involves experts by experience going in to supported housing, residential and nursing homes to check three key areas:
1.Is it a good place to live in?
- Do people feel valued in the community or at work?
- Are people supported to have a full range of relationships and a social life?
It was reported that numerous positive changes for individuals have resulted from their feedback reports. Advonet plan to extend the scheme to other client groups and share their practice widely.
Angela Catley from Community Catalysts made the case for the importance of doing things differently in an age of service and cost reductions. Community Catalysts aim to find ways to get more for less by unlocking local assets and resources and finding creative ways to deliver people’s support (1). A partnership project called Enterprising Minds with the charity Hansel and North Ayrshire Council supports people with learning disabilities or autism to develop their community involvement. Successes included a young woman with a severe learning disability who combined her love of baking and dogs to set up a dog biscuit business (2). Community Catalysts worked with Oldham commissioners in 2010 to support 18 people to start their own enterprises. One of these was DanceSyndrome, recently featured in Community Living (3). Angela ended with the inspiring words of Eddie Bartnik, the pioneer of ‘Local Area Coordination’: “People … are not just passive recipients of social and health care but have expertise, gifts, strengths that can help them achieve their vision for a good life, contribute to their local communities and maximise the impact of resources” (4).
References
- What can be achieved when people are seen as active citizens, Community Living, 31 (1), 2017.
- See ‘Enterprising Minds’, 2015 http://www.hansel.org.uk/Uploads/users/wmcgill/99da720cf95d405a21f7d6b49baf7c4f/1432741231_jxUz0a7E_hanselenterprisingmindsmay2015.pdf
- It’s lift-off time for DanceSyndrome as Jen’s dream comes true. Community Living. 30 (4), 2017.
- Bartnik, E. (2008) Active citizenship and community engagement – Getting serious about more positive pathways to relationships and contribution. Intellectual Disability Australia 29 (2), 3-7.
To access the presentations from the day go to http://www.ncctc.co.uk/presentations/oct-2017/
For a full report from this conference go to Community Living: www.cl-initiatives.co.uk
