Reforming crisis-driven social care through local area co-ordination

Can an Australian idea provide a better local answer to transforming social care services? By Simon Duffy

Social care is now awash with the rhetoric of reform. The government hopes that an increased emphasis on community, on prevention, and personalisation will transform social care to improve quality, reduce demand and generate efficiencies. These efficiencies are necessary because local government must cut £11.3bn from its annual budget by 2015 and about 50% of this will inevitably come from social care for children and adults.

At the moment, social care services are both triggered and shaped by crises. When families can no longer cope, when an adult has a breakdown, or when an older person ends up in hospital, then social care must respond. Yet, when it does respond, it does not know the person, does not know their community and has no relationship of trust on which to build. So, quite naturally, it must provide services, which are often expensive and institutional.

Changing this pattern is not easy. To simply talk about returning to community social work or community development is not enough. Often, initiatives that seem very promising on paper lack the necessary rigour and discipline to challenge this long-term pattern of crisis-driven care. Instead these new projects are sacrificed when times get tough.

Interestingly there is one international innovation that already has a strong track record in reducing crises and preventing institutional services. This system is called local area co-ordination (LAC) and it was originally developed in Australia by Eddie Bartnick, the mental health commissioner for Western Australia. A new report by the Centre for Welfare Reform outlines this model and summarises the findings of several research reports. The model seems to deliver savings, increase the numbers receiving support and reduces reliance on expensive services.

Critically, local area co-ordination requires local government to make a firm commitment to embed well-trained professionals within local neighbourhoods. It is only by making this real commitment to the local community, by forming relationships with individuals and by engaging directly in those communities, that you can avoid falling back on the old pattern of crisis-driven care.

However the report’s author, Ralph Broad, also argues that the model must be implemented with integrity. Local area co-ordination is a skilled role and has its own disciplines and structures. It is an approach that will appeal to many social workers. However it is not merely community social work. Many social workers in Australia have chosen to become local area co-ordinators, but they were joined by others with different backgrounds.

Local area co-ordination must also stay connected to assessment and commissioning. If it becomes too detached then it will not be able to influence the necessary changes. Four English local authorities – Cumbria, Derby, Middlesbrough and Stroud – have begun to pilot local area co-ordination. They are working with a new social enterprise, Inclusive Neighbourhoods, in order to ensure that their implementation builds on previous international experience, while staying relevant to the changing context of social care in England and Wales.

Simon Duffy is director of the Centre for Welfare Reform