New models could change the shape of social care

A scheme being piloted in Leeds could transform the way older people are supported – and save money – by encouraging investment in the community. Ian Wylie visits the city to find out more about the project

Jean Saunders is glad to be back in her bungalow in the former mining community of Swillington, near Leeds, sat safely in her favourite chair after the latest in a series of falls led to another hospital stay. But the 69-year-old, who has Parkinson’s disease and has been taking antidepressants since her husband died earlier this year, says it is neither medical care nor bereavement counselling that she needs most – but company.

“I’ve been lonely, just stuck here by myself, and don’t see many people,” says Saunders, who worked for 27 years as a sheltered housing warden. “My daughter, who lives on the other side of Leeds, comes twice a week to see to my shopping, and I get on all right with the neighbours. But some days the only person I see is my carer at breakfast time. It can feel that nobody is caring, that I’m being left out.”

Then she adds: “But since Trevor came on the scene, things have been a lot better.”

Trevor is Trevor Stephenson, a Leeds council social worker, who has been finding ways that volunteers from a local “neighbourhood network” group, Garforth Neighbourhood Elders Team (Net), might introduce a little more companionship into Saunders’s life.

“It’s surprising where you find social isolation,” says Stephenson, who has been in social work since 1982. “You can be talking to someone who, on paper, has a good support network, yet in terms of meaningful contact, they don’t have a lot. I’ve come across so many resilient older people who have just accepted that old age means loneliness. They might live in a community, yet they are isolated from it.”
Quality of life

His work with Saunders is part of a pilot scheme exploring an innovative concept that goes by the name of Combining Personalisation with Community Engagement (CPCE). If successful, it could assist councils to reduce their social care spending, help the NHS to cut hospital costs and bring investment into local communities. Most significantly, though, the scheme aims to give older people a better quality of life, enabling them to live longer independently in their own homes.

And here’s how it would work: older people who are eligible for care under the Facs (fair access to care services) system, and who wish to take a personal budget, would choose to supplement or replace the council-provided elements of their support packages with more tailored services, provided by local social enterprises and their volunteers. The money saved through using volunteers would be split between the council and the social enterprise, which would invest its share in the community.

For Saunders, it’s working like this. After completing a “lifeplan” – a side-and-a-half A4 summary of her needs and aspirations – Stephenson has agreed for her support package to include transport by volunteers to Garforth Net’s weekly coffee morning and luncheon club. A volunteer will also be helping her regain confidence on her mobility scooter, while another will take her out for walks in her wheelchair. Lifeplans for other people have included weekly fishing trips, pub lunches and church visits. Saunders will also still receive personal care from a professional care worker.

The idea belongs to the Stamford Forum, a social policy ideas network. “This could change the shape of social care over next 10 years,” claims Ritchard Brazil, one of the forum’s founding members. “The savings could allow local authorities to use their funds much more effectively and, more importantly, make it possible for individuals to receive better services that improve their lives.

“It would also free social workers to get back to doing what they are trained to do, rather than being care managers or glorified accountants.”

In addition to the work in Garforth, pilots are running in other parts of the UK. “CPCE is an exciting opportunity to shift more resources to communities,” says Mick Ward, Leeds council’s head of commissioning. “It’s a chance for older people to change from being passive recipients to being in control of those resources. But it also shifts control of resources to communities which can decide how CPCE savings can be reinvested, whether that’s to set up a community laundry or increase community policing.”

Leeds council has made cutbacks of almost £150m over the past two years and the adult social care directorate predicts a 15% reduction in spending power over the next four years. Directorate deputy director Dennis Holmes says he is expecting CPCE to deliver personal budget savings of about 5%, but believes the “ultimate prize” with initiatives like CPCE is “whole system savings” – fewer hospital and residential care admissions.

“Nursing and residential care is my biggest single item of expenditure – £72m a year,” says Holmes. “If people stay in residential care for shorter periods of their life, that will generate great savings to us.”

The financial climate has “sharpened our desire to find new ways of doing things,” says Sandie Keene, Leeds’s director of adult social care. But she concedes there will be challenges in extending CPCE across the city.

“None of us assumes this is going to be easy,” Keene says. “We have to build capacity in our communities and there’s culture change within the local authority to overcome as well. Social workers are used to doing things a certain way. However, some might remember when social workers used to be more community-based. We need to marry up that history with the present.”

Brazil admits that not all local authorities are ready for CPCE – few councils, for example, have community infrastructure as mature as in Leeds. Even in Leeds, it has yet to be proven whether the well of volunteers from the 37 neighbourhood networks, which include Garforth Net, is deep enough to support CPCE in significant numbers – although Brazil maintains it will attract volunteers who see it as a skills ladder for entering the social care sector.

Stephenson acknowledges that some of his social worker colleagues may struggle to embrace the new model. “Some might fear for their jobs,” he says, “but social work has become more about assessing people’s needs, and figuring out what support they need, instead of outcomes.

“I can remember working in a system that wasn’t as bureaucratic and prescriptive, where you could work more flexibly. I think CPCE would allow us to be social workers again. It feels more like what we ought to be doing.”