Wellbeing, resilience, autonomy, connection to others - goals for person and community-centred services
Alex Fox, CEO, Shared Lives Plus and Independent Chair of the recent joint Voluntary, Community and Social Enterprise (VCSE) review, spoke at the recent launch events for Realising the Value final learning and resources. He has summarised key points from his talk for us.
It’s easy at the moment to focus on what we cannot do. The long-unaddressed challenge of demographic change, coupled with the self-inflicted crisis of austerity, has in many areas squashed ambition, compressed the available timeframe and squeezed the money that organisations feel able to invest in change. Looked at in this way, even person-centred health and care can seem an unrealistic ambition, rather than the most basic starting point.
As a small organisation supporting a little known sector, at Shared Lives Plus we have often had to ask ourselves whether it is really feasible to grow our ambition to match the size of the challenges we face, or if we need to limit our ambition to the available resources. The answer to that question, as always, can be found with the people whose lives and happiness are at stake: people with significant and often lifelong support needs who demonstrate to us time and again that anything is possible providing we refuse any limits on the ambition for an ordinary life.
The deepest fissure running through our public services is not the gap between the money we spend and the support we need to buy. That gap is big but bridgeable, if we choose to return our level of investment in public services to one comparable with similar nations, however, this may not be likely in the current economic climate. The deeper and longer-standing chasm is between health and care goals when seen through people’s eyes and the goals as they appear to unwieldy bureaucracies. Pursuing a good life in a good place should not feel audacious or ambitious. If people’s lives seem complicated and messy to services, that is because those services have not fully included people in their design and delivery.
Our challenge and our opportunity now is not to add person- or community-centred approaches like peer support, self-care or indeed Shared Lives and Homeshare as another demand into a stressed and complex system. It is to have the humility to recognise that only people who use services and their families can design the simplicity we need. The VCSE sector has a crucial role to play here, not just in delivering support with more humanity, but also in reaching and engaging the people with the most at stake, who we need to become our co-designers, co-commissioners and co-producers.
Some VCSE organisations already work like that. They are often challenged to ‘scale up’, but an equally valid challenge to organisations which have outgrown their communities is to scale what they do down, to become more human-sized again.
If we do that lots can change. Family carers, whom we too often ignore, will access the information, training, back-up and resources they need in order to sustain their vital caring roles. Services will seek to nurture the social connections from which real wellbeing often stems and will tread more lightly upon informal networks of support. Loneliness will feel like a health issue as important – and preventable - as smoking.
Designed and delivered with, rather than for people, our public services could replace their bewildering lists of targets with some simple shared goals: wellbeing, resilience, autonomy, connection to others.
Those are goals which we can all recognise when we see them achieved, but which our current systems do not currently measure, expect or pay for. Goals which can only be achieved by bringing together the strength, creativity and love of family and community, with the expertise, resources and skill of professionals.
This is an ambition much bigger than the people in this room. We are describing a system which still needs money, but which has goals which cannot be bought. In other words it requires a movement. One we can all support, but which none of us may be best placed to lead. Today’s report helpfully and clearly describes a new kind of health and care system. Our next challenge is to find the people out there best placed to lead us in building it.