This article forms part of the LGA's Re-thinking local think piece series.
During over a decade-long funding squeeze, it’s understandable that many local authorities have sought to ‘manage’ demand - reducing the number of people who need formal care. This imperative often leads local authorities to focus on the ‘front door’, which in adult social care usually refers to where people first arrive when they contact social care.
It has been tempting to see strengths-based or asset-based approaches - those which concentrate on people’s strengths and social networks as well as their needs - as the answer to demand at the front door. The view is that if only we could divert people away from formal assessments at the front door by helping people draw on their own strengths or networks, then we would finally succeed in getting on top of rising demand.
Questions and answers
There are two problems with this line of thinking. Firstly, whilst the front door can indeed be badly managed and can lead to rising demand, it is only one part of the care pathway, with the potential for demand to be mismanaged elsewhere, e.g. when someone is discharged from hospital, or during assessments.
Secondly, and more importantly, strengths-based approaches are not a technical intervention which you add into one or two parts to the care pathway and expect results – the concept is an all-encompassing philosophy which guides the way we lead, plan, design, commissioning and deliver care. The goal is not to tinker around the edges, but to totally transform how we deliver care in local places.
One of the big lessons from the Covid-19 crisis is that beyond the boundaries of statutory services, we have seen communities brimming with people willing to help one another. The groundswell we’ve seen of people getting involved in mutual aid during the pandemic has underlined the huge amount of capacity which resides in communities; and on which a better social care offer could be built.
Strengths-based approaches and sustainable change
But to harness this community power, we need to think much more broadly about strengths-based approaches. Tempting though it is to narrow down the focus of change onto a small number of tangible service areas, the only way to achieve more transformative and sustainable change is by adopting a whole systems approach.
One of the big lessons from the Covid-19 crisis is that beyond the boundaries of statutory services, we have seen communities brimming with people willing to help one another.
How do we do this? The Social Care Innovation Network, which SCIE leads with the Think Local Act Personal partnership and Shared Lives, has produced what we hope is a useful roadmap called Asset Based Areas 2.0. This resource sets out ten key commitments which local systems leaders need to make; governing everything from leadership and commissioning, to co-production and the workforce. This is to create a sustainable system which ‘values people for who they are and the strengths and the potential they bring.’
One of the key commitments is that ‘We [the local systems leaders] have a clear, shared story about how we work and what we want to change.’ This is exactly what Kirklees Council are trying to develop. The council wants to create a social care system which is ‘about valuing people for who they are, the strengths and potential they bring; leading healthy, happy lives, where they are in control and able to make the best choices for themselves and their families’. Now, with SCIEs support, it is further co-producing this vision with local people, and creating a widely owned plan for developing and embedding strengths-based approaches across the whole area.
Vision for change
This does not mean, however, that by focusing on the bigger picture you forget about other important parts of the service, like the front door. It’s important that those working at that front door or in any part of the service for that matter, adopt strengths-based approaches. But changes to the front door must be included in a wider, whole-systems approach to embedding strengths-based care.
This is the goal in the London Borough of Bromley, with which SCIE are helping to create a strengths-based care and support system. They have started with a powerful vision for change, which is co-produced with partners and people who use services. They have then looked at all aspects of their services, and explored opportunities to embed strengths-based practice. Included in their scope for reform, for instance, are strengths-based care and support plans, the operations at the front door, information systems, commissioning plans and the approach to reviews. All will follow a strengths-based path.
Creating a strengths-based sustainable model of care is increasingly the driving vision for adult social care. But to get there we will need to see a change in mindset and organisational culture. It requires leaders and organisations to share power, resources and knowledge, and measure success differently. Tackling the problems at the front door, and in other parts of the adult services like assessments, care planning, and reviews, all remain crucial objectives. Yet they should only be part of a wider whole systems strategy for creating a strengths-based local places.