Ian McCreath: Director of Think Local Act Personal

Think Local Act Personal wants a society where everybody can get the care and support, they need to live well and do more of what matters to them. 

Lives enhanced by great personalised care and support, not a life defined by what social care and health services make available. 

Our co-produced ‘Making it Real’ statements set out what this might look and feel like from the perspectives of people and systems, workforce, and providers. It naturally looks at what it means in the context of community and living an active life in supportive communities: 

• I have people who support me, such as family, friends, and people in my community. 
• I can meet people who share my interests and have the opportunity to join and participate in a range of groups.
• I feel welcome and safe in my local community and can join in community life and activities that are important to me. 
• I have opportunities to learn, volunteer and work and can-do things that match my interests, skills and abilities. 
• I have a coproduced plan that sets out how I can be as active and involved in my community as possible. 

It is only with this final point- the importance of having a co-produced plan- that any sense of a care and support ‘system’ comes into focus. Everything else expresses hopes and expectations rooted in everyday life, not ‘service land’. Here the role of care and support is seen not as a destination in its own right, but as a means of giving each person what they need to live their own ‘gloriously ordinary life’ (however fabulously spectacular some may choose that to be!)

So what’s the challenge here?

On the one hand we know a lot of what needs to be in place. We know why it’s important to us as citizens, in the context of Care Act law, and more recently to assurance too, with the integration of Making it Real into CQC’s Single Assessment Framework. The difficulties, as might be expected, are in understanding how to make this happen when faced with real world obstacles, such as:

1. A place we call home: Limited access to suitable accommodation for individuals with diverse needs can impede innovative care and support solutions that sustain everyday living and fulfilment.
2. Budgets and resources: Insufficient funding and resources pose significant challenges to innovation in adult social care. Budget constraints often force organisations to prioritise immediate needs over long-term innovative initiatives, limiting their ability to explore new approaches and technologies. Too often, commissioning is seen as a tension between achieving either scale or personalisation but rarely at the same time.
3. Procurement bureaucracy: Cumbersome procurement processes, both at the national and local levels, can stifle innovation by creating bureaucratic barriers and delays. Streamlining procurement procedures and promoting innovative procurement practices are essential for fostering a more conducive environment for innovation.
4. Time constraints: The fast-paced nature of adult social care often leaves little time for reflection and innovation. Care professionals and decision-makers are frequently focused on day-to-day responsibilities, leaving less room for creative thinking and exploration of new ideas.
5. Risk aversion: Fear of failure and reluctance to deviate from traditional approaches may deter organisations from experimenting with new solutions and technologies. There is a lot at stake from both action and inaction!
6. Funding constraints and red tape: Much of the innovation we see is found in the local and the personal, and these tend to be micro or small organisations with less capacity to navigate complicated systems, funding applications, and procurement requirements.
7. Legacy funding models: Traditional funding models that prioritise short-term fixes over long-term innovation can inhibit progress in adult social care. Shifting toward sustainable funding mechanisms that support ongoing innovation and change is essential for driving meaningful improvements in the sector.
8. Policy and political factors: Political dynamics, policy frameworks, and market forces can also influence innovation in adult social care. Aligning policy objectives with innovation goals and fostering collaboration between stakeholders are essential for overcoming these systemic barriers.

These problems have become so entrenched they can often leave people feeling they are inevitable, but they really aren't. We know this because alternatives exist and continue to thrive despite the adverse conditions. 

At Think Local Act Personal, we have been listening to and learning from those whose creativity and tenacity have allowed them to make it real. From this it’s possible to identify consistent features of success:

1. Co-Production and engagement: Involving people with lived experience, as well as providers, in the design and implementation of solutions is essential. Co-production not only ensures that initiatives are tailored to meet real needs but also enhances their effectiveness and sustainability.
2. Budgets and resources: Adequate funding and resources are fundamental to fuel innovation. Without sufficient financial support, it's challenging to implement new ideas or sustain existing ones.
3. Time and space for thinking: Innovation requires time and space for creativity and reflection. Overcoming the lack of thinking time means carving out dedicated periods for idea generation, planning, and reviewing initiatives. Creating a local culture that values and prioritises such time is vital.
4. Risk-taking: Embracing a culture that encourages calculated risk-taking is crucial for innovation to thrive. Decision-makers need to be open to trying new approaches and learning from both successes and failures. This shift in attitude toward risk is essential for fostering innovation at all levels.
5. Streamlined procurement processes: Streamlining procurement processes and fostering innovation within procurement teams can help remove barriers and support innovative commissioning practices.
6. Long-term funding commitment: Securing recurrent funding and making long-term commitments to change are essential for sustaining innovative initiatives beyond the initial phase. Short-term fixes or trials may yield temporary results but often fall short of creating lasting impact.
7. Timeliness: Shifting the focus away from purely reactive services based upon eligible need toward prevention and early intervention opens up opportunities for innovation. Co-producing solutions with communities and investing in prevention efforts can lead to more fulfilling lives, vibrant communities, and sustainable public services.
8. Capacity building and collaboration: Building the capacity of both commissioners and providers to innovate is critical. Establishing peer networks, sharing best practices, and fostering collaboration across agencies can catalyse innovation and drive positive change.
9. See what’s hidden in plain sight: In every community there will be people and groups acting as community change agents, mobilising the strengths of the people being supported, their families and networks, yet operating outside of directly commissioned adult social care. Foster, encourage, nurture but don’t take over, the strength, opportunities and diversity that is all around us. 

The Care Act, ten years on, remains a good piece of legislation but it’s suffered from inconsistent implementation and political will. Much of the answer rests in local areas working with citizens to develop a clear unifying, integrated vision of care and support ‘in their place’. To move things forward constructively and decisively, we must start from a realistic appraisal of where we are now. 

Only then, and in coproduction, can we focus our collective energies on where they are most needed to progress towards making it real for all.