Living Ambitions (Provider)

I was out and about on my travels the other day at a meeting with providers in a neighbouring county. As is traditional with these things, we were invited to ask questions and encouraged to introduce ourselves. Me being me, always has a question (or two) to ask, and dutifully explained who I was before I did so. At the end of the meeting, I was approached by a lady who stated that she had read this blog series and had a question for me. Now I am unsure what intrigued me the most, the fact that someone actually reads the blogs I write or the question she asked.

The question was this "What's the secret to creating and maintaining a person centred culture?" On the surface, the question appears innocuous enough but in reality, it requires much thought and not an insignificant amount of analysis. People who know me, will tell you that I shoot from the hip when answering questions or making comments. I tend not to need to think about things as the answers are often second nature, however not in this case. I paused for a minute and then said something suitably ambiguous to disguise my lack of direction in answering. I may have said "Well there's no secret. It's all about having a vision and a passion to make things happen and staying focused on what you are trying to achieve". Which of course is right, but actually that's not the answer. The vision is the start, the seed if you like, but if you ask a gardener what is needed to make a plant grow, they will tell you that planting the seed alone, is not enough.

So into my car I got and drove back to Living Ambitions HQ pondering the question, certain at that point that it really isn't a secret, but uncertain what the key to achieving a person centred culture is. Now just a small point here, don't think that I am contradicting myself by thinking that we have actually achieved a person centred culture because as you will note from my March blog that isn't the case. But we are on the way and it was how we had got this far that I wanted to understand.

I thought back to the person centred thinking tools that we used and whether these were the key. In part they were, but they weren't the common denominator. How about training? Once again a significant help but not exclusively the answer. More head scratching ensued, recruitment? Nope, once again important but once again not the single most important thing to make a person centred culture grow. So what then was the golden thread? I can almost hear you all shouting in Monty Python Styli, "Get on With It!" and so I shall.

The answer, once it was forthcoming, was relatively simple. I'm not sure about you but I get thunderbolt moments that occur almost anywhere and at anytime. On this occasion it struck when I was talking with a colleague from another organisation about the challenges of developing a person centred culture. They were discussing how hard it was to get everybody to understand what was needed and what was involved. I stated that it was indeed a challenge but provided that you had a communication strategy in place. "That's it, Communication!" I shouted, scaring my colleague half out of her skin and losing a few professional dignity points on the way.

From the outset of the person centred process communication is paramount. Obviously for support planning we develop a Communication Passport, but more than that, we communicate with families, care managers and an individuals circle of support, about what the process is and their shared expectations. The other strand to communication is with staff teams, constantly re-enforcing the message about what it means to be person centred and how it looks and feels for the workforce.  Making sure that the culture is tested and checked, speaking to people who use our services to check that they are happy with what's being provided and that they really are at the centre of their support planning.  It is a constant process of consultation, listening, responding and re-enforcing about what the message is and how it applies to all areas of the organisation.

Those of you of a certain age will remember a well known TV ad for BT that stated "Its good talk", they weren't wrong! So the secret of developing a person centred culture is communication, communication and communication and when you think you have communicated enough carry on and communicate some more.

It's been nearly a year since I started writing these blogs and to be honest the time has flown by. One of the first themes that I discussed was the need for getting the right staff on board, not just in terms of skills, but also in terms of values. The last blog that I wrote discussed the need for re-invention and innovation so I thought I would combine the two and let you know what our Person Centred Task Group has done with our recruitment process over the last year.

I'm not going to do what many T.V series do and replay an episode, or blog in this case, tagging a new bit on the end for the last 5 minutes (Grand Designs, to name but one). I thought I would just let you know what we are doing over and above what we developed a few years ago.

We found that having a person centred recruitment process and using the staff matching tool was working up to a point. We had people who performed well at interview, looked to be matched, but then when they started working, seemed to have had a personality transplant and metamorphosed into someone completely different to that which we interviewed. Now this wasn't happening on a regular basis, but it was happening often enough for us to ask the question, how do we know people are genuine? The question was further complicated by the need to provide evidence to ensure that we were compliant with equality legislation (in the old days a gut feeling would do). So the Person Centred Task Group got to thinking about the problem and a way forward. One of the group had heard of another organisation who sent out blank one page profiles to candidates so that they could better help to shortlist against the staff matching tool. This was considered to be a good idea, but fell a little short of the "checking out" function that was required. So the idea was born to establish after the interview process a "Values Workshop".

The "Values Workshop" provided the opportunity for us to get candidates together and discuss with them Living Ambitions culture and philosophy. The content was geared to look at person centred approaches and discuss "Mavis" (see blog 2). From these discussions the concepts of citizen led rotas', enablement and empowerment, circles of support and step down support are all introduced and debated. The format of the workshop is designed to encourage conversation between candidates around these areas. We also run a number of scenario based activities which further seeks to identify what people feel about the topics discussed. The idea is that by hearing candidates talk about these issues, we can test out whether what was said at interview, is borne out when discussing real life examples and practice. As this forms the final part of the initial recruitment process, citizens also contribute to the workshop explaining what life is like for them and what they expect from their support staff. The workshops have been running for a few months now and individuals who may not have understood what we are all about, certainly do by the end of the day.

We have found that by testing out the values of potential staff in this way, they are better able to grasp the expectations of our organisation and we are better able to assess that they mean what they say.  I suppose you might say it's our way of checking that staff "do what they say on the tin". So far it seems to be working well, however, the Person Centred Task Group will be keeping a watching brief to ensure that it fulfils it's desired purpose.

At Living Ambitions we recognise that it is really important not to get too complacent about the support services that we provide. If you met me at a conference or similar event, you would always hear me referring to Living Ambitions as "working towards a person centred culture" or being "on a person centred journey". Now some of you may think that this is a bit strange, coming from an organisation that writes blogs for Helen Sanderson Associates and has won awards for its innovative person centred support delivery. However, developing a person centred culture is a bit like painting the Forth Road Bridge (or for our American Cousins the Golden Gate Bridge), you can't stop working at it, because if you do the culture becomes flaky, dull and chips away. I'm sure there are other analogies which would work equally as well, so feel free to add your own.

This of course leads to another consideration, how the heck do you keep working towards something that will never fully be reached. The answer to the question can be found in some of the great automotive houses of the world. I am a self confessed "petrol head", I have a passion for cars and everything motorsport, so please bear with me because there is a point, I promise. Take any of the great car manufacturers of the world, for me I'm going to stay British and go with Aston Martin. If you look back through their company history, you will find many great, beautiful, technically excellent cars, many of which are iconic, largely due to a certain Mr Bond as well as racing success at Le Mans. But why didn't Aston Martin just stick with the DB1 or the DB5 (007's machine gun touting, passenger ejecting plaything). Quite simply, Aston, as do all the other major car manufacturers, realise that excellence never stands still. Development is an essential part of their business and it needs to be the same with Social Care. Aston Martin spends a huge amount of resources doing research and development, discovering how they can make their current cars better and designing new ones for the future, each one better than the last.

Obviously there are commercial and competitive elements in the automotive world which are arguably different to our own (or maybe not). But Living Ambitions is in competition with itself; every time we provide support for an individual we want that support to be better than it was before. So we have set up the social care equivalent of a research and development team. Well almost, in fact we call it our Person Centred Task Group. This group consists of people from across the organisation, including input from people we support, to establish how we can improve what we do. When the group was set up, it developed its own Primary Purpose to underpin that of Living Ambitions and then went on to develop its own core principals, also complimentary to our organisation's principals. This task group is a vital check and balance to ensuring that we are constantly seeking new ways of maintaining and implementing person centred thinking throughout our organisation. If you haven't already put this type of group together I would recommend that you think about doing so. Ours uses the Positive and Productive format (in fact all our meetings do!) and after an initial ice breaker round, undertakes a "what's working, what's not working" exercise from which the meeting develops its own agenda, developing solutions to issues and generating new ideas. These meetings produce a lot of innovative ideas and also help to benchmark our performance against the "Progress for Providers for Managers Tool". In fact I'm going to put my neck on the block here and suggest that it would be very difficult to use this tool effectively without having such a task group.

As I mentioned, we recognise that our journey is on going and ultimately will not end, but our motivation is to constantly strive towards person centred excellence. Now where's that Vodka Martini Miss Money-Penny?

So 2012 has finally arrived and what a great year it promises to be. We have the Olympic Games in London, the Paralympic Games, in Football we have Euro 2012 (no doubt England exiting once again on penalties), the U.S Presidential Election and the Queens Diamond Jubilee. At Living Ambitions, we also hope that this year will continue to be a good one for all the people we support.

It's around this time of year, that Jodie and I assess all the information that we have received from our various feedback events and try and establish our core priorities for the year ahead. We gain feedback from the people we support in a number of ways, some of which are traditional i.e. accessible questionnaires and service user forums; some ways are slightly more innovative, we have a citizen consultant who also uses our support services and is employed to go and visit people in their homes, establishing how they think we are doing. We commission an independent organisation to facilitate a series of annual events with people who use our services, to gain their feedback on what's working, what's not working and we use computer tablets for on line surveys etc. But having all these ways of gathering information is not much use if you do nothing with it.

Living Ambitions makes a commitment to the people who access its support services, that they have an equal part in shaping the direction of the organisation. This was clearly demonstrated when we worked with people supported and staff, to develop our organisations new Primary Purpose and Core Principals. But not content to rest on our proverbial laurels we also use the flow of information to inform what we do in each business planning cycle. One of the problems we found, was that most people we support didn't really want to get caught up in the terminology around business plans and measuring these by performance indicators. The feedback we were getting was that all people wanted to know, was what we were going to do for them and how this was going to make their lives better.

So with a bit of head scratching and some fairly interesting discussions, we hit upon the idea of having some New Year Resolutions.  Having listened to what we have been told by the people we support, Living Ambitions, in partnership has made the following resolutions for 2012.

1) To work with service users/citizens and develop a Service User Charter. This will be our Personalisation Manifesto and will make clear our commitment to our core principal that everything we do is person centred;

2) We will work with other organisations to share good practice, learning from each other to ensure that person centred approaches becomes the only way that support is provided;

3) We will work with Service Users and their circles of support to establish how using the latest technology can reduce the need for paid support and help them to maximize their independence;

4) We will work in  local communities with other agencies to raise awareness of hate crime and to ensure that all people with a disability are free to live in their communities without fear of abuse and harm;

We are looking forward to working with all our partners to make these resolutions a feature of our work over the next year and will provide you all with feedback via this blog. At least by working together, these resolutions will undoubtedly succeed, unlike my "go for a daily run" resolution which only lasted a week.

Firstly I'd just like to use this blog to wish everyone a Merry Christmas. I'm sure all of you have been busy supporting people to organise and plan their festivities and at Living Ambitions things have been no different. I am not sure about you but it's normally at this time of year that I tend to reflect on what has happened over the previous twelve months.

Hopefully there are some of you out there that read my monthly contributions and have been following our journey towards a Person Centred Culture. But maybe there is a "so what" thought that enters your mind every now and then. Now if there is, don't worry. I am referring to the thought that might say "So what difference does it make" if you have a person centred approach to risk, if you use communication passports or if citizens recruit their own staff teams?

"So what difference does this all make?" It was during a period of quiet reflection that someone came into my office and it is their story I am going to share with you. I feel that their journey perfectly describes what difference person centred approaches make to peoples lives.

So I'll start with a bit of background, Ted is in his 50's and has a learning difficulty. He lives in a tenancy with three ladies. They have been housemates for many years and were previously supported by an organisation that didn't understand or practice person centred thinking. A few years ago, Living Ambitions was called late one evening to ask if we could take over the management of Ted's and his friend's support, as there were concerns about the service and how it was being run. When we first visited the house, there were those tell-tale signs that things were maybe not quite right, none of the tenants opened their front door; there was a visitor's book; the tenants were asking staff if they were allowed a cup of tea; there was a staff toilet and staff mugs. However, being open minded and not wishing to rush to conclusions, we sat down and began discussing with the tenants what they did with their lives and how things were going generally. To be fair Ted and his house mates seemed to be happy and content, but still there were things that didn't feel "right". On walking around the house, Jodie noticed a sunbed in the Sleep In room, "so which one of you likes to have a tan" she asked. As soon as the words left her mouth the answer became obvious. We looked at Ted and the other tenants, all white skinned obviously having never been near any U.V tubes and then at the mahogany tanned staff member sitting on the couch. "We are not allowed to use the sunbed" explained one of the other tenants. Obviously in a bit of a panic the staff member stated "its ok we {the staff} pay to hire it". As Jodie picked her jaw off the floor, I suddenly felt the need for some fresh air. Imagine "Mavis" (Jodie and I's imaginary housekeeper) , placing a sunbed that she had hired, in our house without permission, jumping on it when she had done her dusting and then telling us we can't use it. It defies belief doesn't it? I don't think that the staff meant to be malicious, they just didn't think in a person centred way. Although there was one staff member who did and I'm proud to say he is still with us. From this point the whole service began to unravel and there were more and more examples of poor practice and institutional care.

At the first "what's working, what's not working" session, Jodie sat with the house mates and asked them how they felt about their lives. Our initial view, that they all seemed happy was right, but when the questions started being asked about "what do you want to do?", then it became apparent that the group had dreams and aspirations, but had been told that they "couldn't do" or "shouldn't do". The light bulb moment came for them when we started to develop their support plans with them. We used a PATH for each of the individuals and for the first time, they could see that they had actual choices and control over where their lives were headed and what they wanted to do. At first the group struggled with having the increased level of choice. They needed reassurance that it was ok to make their own coffee and decide what to eat for their tea. It was ok to choose where to go on holiday and who they go with, rather than going en mass. But with support and some workshop based training, they began to get used to the idea that they could make decisions for themselves and that the house they lived in, was their own. We supported Ted and the rest of the group to develop their one page profiles, staff matching tools, communication passports and a range of other person centred thinking tools, to support the outcomes they wanted to achieve. The difference was incredible. The group were going out on their own, learning new skills and making new friends in the community. For the first time in over half a century, their lives had expanded beyond dependency on paid support and they were achieving genuine positive outcomes that they had chosen.

So it was Ted that walked into my office:

"Hello Robin?"

"Hi Ted. How are you doing mate? What have you been up to?

"I've just got back from my holidays?"

"That sounds great. Where did you go?"

"Memphis, I went to Graceland. It was really good! Ste and I went….. Robin why are you crying?"

"I'm just happy for you Ted. When I first met you 3 years ago, you told me that you always dreamed of going to Graceland and now you have. Sit down mate and tell me all about it"

The answer to the "so what difference does it make" question is this, person centred thinking and support is life changing. It takes people out of the tunnel of having their lives directed for them and into a world of endless possibilities, choosing which direction to go next. Yes, when individuals leave the tunnel the bright lights of choice and control can be a bit blinding but with the right support, people soon get used to being out of the dark and can see the way for themselves.

Don't believe me? Ask Ted!

Over the last few years, Jodie and I have been working hard to establish a culture within Living Ambitions that reflects our values. One of the problems that we had was that no one knew what the organisational values were, in fact Living Ambitions in 2009 had two mission statements depending on what document you were reading and over 30 different values. It was no surprise therefore that when we asked staff and citizens whether they knew what Living Ambitions did and how it did it, we were faced with blank stares and some random guesses.

As now seems to be typical with these blog features, I'm going to jump back a bit to when we were developing our approaches to person centred thinking. Jodie and I knew what we wanted to achieve in terms of changing culture, but there were a couple of fundamental issues. Firstly how could we be sure that what we were hoping to achieve was in line with what the citizens we supported wanted? Secondly, how do we engage a workforce to change their way of working to reflect a totally person centred approach? The first issue was far from easy, but through an intensive period of consultation and planning events it became obvious that the citizens we supported were, (unsurprisingly), wanting to lead their support planning and wanted us to make this a reality.

The second issue relating to staffing required a much more strategic approach. I would like to say that Jodie and I planned the strategy to the finest detail, but whilst there was some planning involved, the employee engagement process became a positive vehicle on it's own that just needed a bit (actually an awful lot) of steering.   I am not going to bore you with the specific details of how we consulted with staff and the intricate process of redesigning terms and conditions to reflect a Citizen Led Support Service, (contact me if you want to discuss though) but suffice to say that at the end of the consultations with Citizens and Staff, together we had designed a new Primary Purpose and New Core Values. In essence everyone helped to clarify what Living Ambitions does and how it does it.

Now I know this may seem obvious but I make no apologies for saying it anyway, but one of the things that really began to develop through our employee engagement process was that in order for Person Centred Approaches to become a genuine feature of an organisation it could not only apply to the people who used support services. Personalisation and being Person Centred, for us at least, is not a Government Agenda, it is a set of values  and it is a belief system. Please don't think that I'm going to stand at Hyde Park Corner and have a rant about this, but it is our belief that if an organisation only applies person centred approaches to the support element of what it does, this is not a value, it is a function. Person Centred Approaches at Living Ambitions applies to every area of our organisation, staff teams, suppliers, people who visit, it is the golden thread that links everything we do. It would be very difficult for a staff member to provide support in an empowering and positive way, if the organisation they worked for didn't show them the same approach and treated them positively and with respect. Holding this belief and applying it to the organisation has required some creativity and innovation in almost all of the traditional H.R functions that an organisation uses to support it's staff. I'm sure some of you will be familiar with the Person Centred Supervision Tool, but what else can we do to support staff using person centred values? Fortunately many of the Person Centred Thinking Tools that are available can be adapted for use with staff teams. Jodie used a number of these tools to develop an appraisal document being utilised throughout our organisation.

The "My Work Review" tool borrows elements of the one page profile, good day/bad day tool, as well as a what's working and what's not working discussion to develop an action plan for staff moving forward. This document looks at a persons' strengths and moves away from more traditional tick box appraisals. We have found through applying person centred thinking holistically across the organisation, we create a ripple effect that extends to every part of Living Ambitions, staff are positively engaged and valued which promotes better quality support and outcomes for citizens. Which let's face it, is what we are all here for, isn't it?

I am conscious that these blogs seem to have taken their own direction with posts ranging from the woeful state of the Nations economy to V.A.N periods and Mavis. However, I guess this is reflective of how an organisation moves along the pathway towards a truly Person Centred Culture. At Living Ambitions, we started off with a belief and a passion to develop the organisation into one that had at its core a culture that was truly person centred, if I'm honest that's probably about it, as far as strategy went. The rest of what we have achieved so far, has been as a result of enthusiasm, trial and error, luck and sheer commitment. One of the main reasons why we write our blog every month is to share with you the journey and hopefully let you learn from our lessons. But whilst, our journey to date has been an incredibly positive one, I can't help but think that life would have been a whole lot easier had there been a "A to Z" type atlas to tell us, which direction to turn. Some reference guide that pointed us in the right direction and then helped us to identify when were heading totally the wrong way.

I am sure many of you are familiar with the Progress for Providers Tool, it is widely regarded as one of the most comprehensive benchmarking tools available for assessing an organisations progress in achieving a person centred culture. I have to declare an interest at this stage as my wife, Tracey, along with Ben, Kim and Helen, helped to develop the original tool, however I'm not just trying to gain favour for a lads night out, the tool is very useful indeed. However it did have a few gaps, which is inevitable when you consider that it covers all areas and levels of an organisation. One of the main issues for me was that it wasn't specific enough with the "how to do?" question.

Living Ambitions hosted two workshops last month facilitated by Helen Sanderson Associates, these workshops are set to be  launch pads for some significant bits of work that we are going to be undertaking over the next few months. The first workshop introduced the new "Progress for Providers for Managers Tool" this is a self assessment booklet and goes some way to addressing the gaps that I feel existed in the original document. The workshop was attended by colleagues from across Lancashire, Salford and Cumbria. As you can see from the picture, there were lots of animated conversations during the breaks and the feedback was very positive. One of the key issues with the Progress for Provider series of tools, is that it's easy to overrate yourself. One of the things we found was that when we first looked at the original tool, we thought that we were all 5's (the top level), however, having attended the training we realised that only a few areas were as high as 5 the others were a bit lower than that. So I would advise that you attend at least one workshop before launching head first into completing the booklet.

Moving on from this workshop, we are developing an in-house work group to undertake the assessment and look at how we can implement any findings. As this is a work in progress, I thought I would let you know what we are up to. I will keep you updated by this blog what we find  as a result of completing this self assessment and how we move forward, however, I am sure that having the Progress for Providers "A to Z" will provide the next stage of our person centred journey  some clear direction.

If I was running a social work course and had to set a discussion topic for my students, one which I am sure would cause some interesting debate would be "Is it appropriate for people supported by services to make their own decisions about taking risks?"

I can see my imaginary students now, all jumping forward and saying "yes" but when questioned a little deeper, "what if someone with epilepsy wanted to go to a nightclub with strobe lighting" or "what if someone who often got lost, wanted to go to town unsupported" or "what if someone wanted to go to Amsterdam to use the services of a sex worker?". I could quickly see the debate becoming more heated as the values of the students emerged through their discussions. You see as we have found at Living Ambitions the risk issue is a difficult one, not actually for the Health and safety reasons you might think but because of some significant differences in thinking.

 Now it is with some unease that I start writing about this issue as I need to be careful that I don't seem critical of anyone. When you consider how many people can potentially be involved in someone's support planning and the different backgrounds that each member of a circle of support can have, it's not surprising that people may have a different approach to risk. Take for example a parent of an individual with a severe learning difficulty, their approach to empowering their off spring to make a decision about risk is likely to be different to that of a care manager or support worker. Neither of these approaches will be wrong, after all in order to assess risk it's important that all eventualities are explored. But it is whether an individual should make their own decision take a risk or not to take a risk that often causes some tensions in the support planning process. The "capacity" argument is quite often debated as is the need for risk assessments, in order to determine what is in the best interest of the individual. However, sometimes it is easy to lose sight of the most important thing, which is that the process of making a decision around risk taking for themselves is often (not always) in the best interest of the individual. After all what's a life without risk? Risks are part of everything we do, crossing the road, going swimming and using the stairs all have an element of risk involved. The risk making decisions therefore need to be a real life experience for individuals rather than  decisions being made on their behalf.

Now, in our V.A.N period (see blog 1) we got a little lost around the decision making/risk issue and crossed the line into advocacy, banging the drum for positive risk taking and sticking our head above the proverbial parapet. However, whilst there is an element of advocacy required by support providers this needs to come with some sound evidence that all risks have been thought through and considered by the individual. Additionally any lessons from historic events need to be considered although not exclusively. It was a young Obi Wan Kenobi who said "be mindful of the past but not at the expense of the future" (Star Wars, for the uninitiated). Meaning that just because something hasn't worked in the past doesn't mean to say that it won't in the future.

During our V.A.N period we didn't recognise the differences in thinking that existed around empowering people to make decisions, especially when these decisions involved some risk taking. The whole concept of positive risk taking is what underpins person centred thinking and therefore it is impossible have a truly person centred culture unless you adopt a person centred approach to risk. I think it's obvious to say that every person centred tool is designed to empower an individual to make choices about their lives.  However there is a specific Person Centred Risk Workbook, which I would encourage you to get your hands on. The workbook pulls together a number of other Person Centred Thinking Tools and creates a clear pathway for supporting individuals to make decisions around risk. There is a training course which guides people through using the workbook and we now have two Person Centred Risk Facilitators in our organisation who support individuals and staff around this area. By using this workbook we have supported people to make decisions from something as straight forward as filling up their mobility car with petrol to going on holiday to the Caribbean. At Living Ambitions, we believe that risks present opportunities for individuals to grow and develop emotionally, we listen to the concerns of other whilst not losing sight of the individual's goals and dreams. Using the Person Centred Risk Workbook we are able to develop innovative and creative solutions to risk taking whilst maintaining a balance and ensuring that positive elements of risk taking are not lost, I think Obi Wan would approve.

I'm going to move away from talking about our journey to Person Centred Nirvana to discuss a couple of issues that are relevant in the here and now. The main one being the elephant in the room that is "Funding". I have read and re-read my blog contributions (for editorial inspiration not egotistical reasons) and I am sure that some of you may have read them and thought "that's all well and good Mr Bush, but who pays for all this?" Local Authorities are at different stages on their journey towards Person Centred support delivery, fee levels are always a challenge, even more so now that we are being asked to make "efficiencies". From our observations things changed considerably during the last 18 months, once the burden of the global economic crisis became apparent. I remember listening to various people from various authorities giving the same message "These cuts are unprecedented". Naively I thought, "I lived through the recession of the 90's, how bad can it be?" Well the answer is, very bad, in fact its ermm........... "unprecedented". Local authorities asking for 15 to 20+% efficiencies; I love Social Care Professionals no matter how painful the message, there always a compulsion to make things seem better, Efficiencies = Cuts. No nice way to say it I'm afraid. Where cuts are not being asked for, there is no uplift in fee's meaning that in real terms, considering VAT being set at 20% and inflation at 5%* and all the other "uppings'" such as fuel etc, the money being paid for support is worth less.

Alas my blogs are not lengthy enough for me to go into all the issues that this raises for Social Care Providers. So I am going to focus on what I consider to be the most important. What does this mean for the people we support and the services we provide? How can 20% be cut from someone's individual budget and they be able to receive the same level of support that was assessed as being needed originally? Well I'm afraid it can't and even if there are no cuts being asked for by the local authority that you operate in, I will bet a banker's bonus, that very soon all packages of support will be reviewed.

So then what to do? Here at Living Ambitions we believe firmly in partnership working and have developed good links with local authorities to try and establish a way forward. After all it's not their fault that there is no cash and even if it was, it is not the fault of the people who I am dealing directly with. Through these positive partnerships we have been able to establish ways by which support can be safely reduced. We have accessed community links, we have developed increased circles of support, looked at sharing staff from across different organisations, utilised the latest assistive technology and in Lancashire we are looking at developing a "Training Bank" whereby providers pool their resources. Now all this sounds, and is, very positive and forward thinking and goes someway to addressing the problem of reducing costs. Our problem was that the process was very reactive and very muddled. We were responding to requests for efficiencies as the trigger for looking at these things rather than having them as a default support planning process. After all, shouldn't we as providers be providing only what an individual needs, no more and no less? Should we as providers be the ones that support an individual to take positive risks? Shouldn't we be the ones that support people to maximise their budget and identify areas for sharing resources across stakeholders? Of course we should (at least in my humble opinion).

I was talking with Helen Sanderson a few weeks ago, discussing various things and was fortunate enough to be shown the "Just Enough Support" planning tool.This adds a clear direction and framework for analysing the levels of support that people need and what is available from other resources. In effect it pulls together our somewhat woolly approach and makes things easier to follow. Jodie and I are really looking forward to working with this tool and incorporating it into our Person Centred Tool Kit. We are also looking forward to sharing it's ideology with our partners in local authorities. Peter Kay felt that the future was "garlic bread" alas I fear he was somewhat misguided. The future for Social Care is adapting to the shrinking resources that are available and making sure that individuals can still access high quality support mechanisms to achieve quality outcomes and lead fulfilling lives. We can only facilitate this if we have an innovative and structured approach to ensure that individuals receive Just Enough Support. I will keep you all posted on how we get working with this tool via this blog.

 In the spirit of partnership we are running a workshop with Helen Sanderson Associates on the 27^th September to help people understand the tool better, if you want to come along drop me an email and I'll let you have the details, robin.bush@livingambitions.co.uk

(* National statistics office figures for the RPI June 2011)

I know I said in our last blog that the one page profile was the initial tool that we used when we are first introduced to an individual as their support provider. But in actual fact that wasn't quite true, yes when we are introduced to an individual the first face to face planning tool is the one page profile, but we also develop a communication passport with an individual if their needs require it. Now the reason for the confusion is a bit like the chicken and egg debate, what comes first the One Page Profile or the Communication Passport? To be honest as with all person centred approaches there needs to be a degree of flexibility, one of the pitfalls that caught us at Living Ambitions was the compulsion to try and develop a framework or timeline where these tools were needing to be used. We quickly learned that  the best way of using person centred approaches was more akin to a set of spanners, you have them all in your tool kit and use the best one to fit the needs of the person at any given time. In some cases some "tools" are not needed at all, and this can be the case with the Communication Passport. Although the value of the passport, if completed correctly is incredible, (this adjective is not used lightly), therefore give careful consideration before deciding not to use it.

The above knowledge of course comes out of some significant learning that we undertook at Living Ambitions, we knew that a Communication Passport was useful. Obviously from a provider perspective it's important to know how a person likes to be communicated with, but in the early days we used it just as a basic assessment tool. Can Peter communicate? Yes. How does he communicate? With symbols, what symbols does he use etc, etc etc you get the picture (pardon the pun) . Now this was all well and good but didn't really give us enough information about the person, especially when you bear in mind that only a small percentage of communication is verbal. If you consider the needs of most of the people we support this percentage decreases further with most communication coming through behaviours. We happened to stumble across a template for a communication passport that was offered to us by Max Neil. Max is the Local Person Centred Co-ordinator for Lancashire and has been invaluable in helping us to get our person centred approaches established. The template that we got from Max went into far more detail than the ones that we had used previously and helped us to look at behaviours and their meaning much better.

Attached is one of the first passports that we have developed and from it you can see how useful it is in interpreting what is being communicated to us through gestures and behaviours. But as you will also see it explains how an individual responds to touch, sight, smells and atmospheres, (maybe we should call it a sensory passport?).  By using these passports we have been able to support people to anticipate situations that may have caused them some anxiety. But more importantly we have been able to establish ways that individuals can acquire new skills through interpreting the positive responses to smell , touch and sound using these to inform learning alongside learning logs (more of them later).

One of the most significant benefits of using these passports to such good effect is the reduction in behaviours that can challenge a service. Through us being better able to understand what is going for individuals we are more confident in our approaches and the person supported feels more relaxed knowing that our responses are going to ones that suit them. These passports have proven of added value for individuals with an Autism Spectrum Condition, as most of you will know communication difficulties are one of the triad of impairments. Therefore individuals with an ASC use subtle and often diverse methods and behaviours in order to help them communicate. Through analysing these over long period of time we are able build up a dictionary of behaviours to helps us interpret what is being "said" to us.

The passport which I have attached is fairly self explanatory so I won't rave on about it. But it is important in order for these to be truly useful tools, to get all the information no matter how trivial from everyone involved. Remember that individuals can communicate differently in different situations and therefore the more information the better...simple really.