'Only a footstep away' - Skills for Care - Think Local Act Personal

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• Lifetime homes: new homes shouldbe built to Lifetime Homes standardsand people in existing homes shouldhave access to necessary repairsand adaptations to make theirhomes last for a lifetime.• Older people’s voices heard: olderpeople must be involved in localdecisions that affect them, and theirvoices heard.• Places to meet and spend time:whether it be a public park, a sharedcommunity centre or a village hall,spaces for people to meet are vitallyimportant to all of us and all ages.• Pavements in good repair: allpavements should be smooth andnon-slip, with a maximum differencein paving-slab height of 2.5cm (1inch), so that older people are lesslikely to fall or to have a fear offalling in their local area.• Public toilets should be provided infar greater numbers as they are vitalto the many older people who sufferfrom incontinence; without themmany people are renderedhousebound. (HtA 2008)local programmes4.29 Local neighbourhood strategies arevariable. Some, such as Local AreaCoordination or Connected Care, arebased upon national templates, whilstothers are entirely locally generated. It hasnot been possible in this review ofpublished sources to undertake a fullsurvey of local programmes, but someexamples are given below.‣ Local Area Coordination (LAC)4.30 LAC is an innovative way to supportindividuals and families to build a ‘good life’and strengthen the capacity ofcommunities to welcome and includepeople with disabilities. The conceptoriginated in Australia, pioneered by thework of Eddie Bartnick (Bartnick &Chalmers 2007), and has become popularin Scotland. Like the NeighbourhoodManager, the LAC acts as a coordinatorrather than a service provider, and alsocontributes to building inclusivecommunities through partnership betweenindividuals and families, local organisationsand the broader community. An evaluationof the Scottish experience of LAC wasundertaken by Stalker and her colleagues(Stalker 2007), but (as in the case ofNeighbourhood Management) it proveddifficult to extract clearly identified andmeasurable outcomes. However, they dosuggest three areas of achievement: abetter overall quality of life for people;specific differences in individuals’ lives; andparticular areas of work such as transitionto adulthood.‣ Connected Care‘Only a footstep away’? 184.31 The Connected Care model aims toimprove community well-being byreshaping the relationship betweenservices and the communities in whichthey are delivered. The stated aim is toconnect health and social care serviceswith housing, education, employment,community safety, transport and otherservices, based upon a belief that the gapsbetween services can be bridged byensuring that the legitimacy of local userand community voices is recognised. Intheir evaluation of the Connected CareCentre in one ward in Hartlepool,Callaghan and Wistow (2008) note that ifcommunity social capital can be builtthrough involvement and devolved power,the role of the state can then become oneof facilitator in a self-sustaining process,rather than a provider of unresponsiveservices. In effect, the production andownership of knowledge would become
the province of the community rather thanthe ‘expert’ professional.4.32 In the case of Hartlepool, acommunity audit was used as the basis forspecifying a new model for ward-basedcommissioning and service delivery whichincluded proposals for workforcedevelopment such as:• care navigators working on anoutreach basis (and possiblyrecruited from among localresidents) to improve access,promote early interventions, supportchoice and ensure a holisticapproach• a complex care team integratingspecialist health, social care andhousing support for residents withlong-term needs• a transformation coordinator tomanage the service and promotechange in existing services so thatthey are joined up.4.33 This all adds up to a significantchallenge to the traditional model, and theevaluators have been cautious at this stageabout making undue claims of success.(Wistow & Callaghan 2008)than a bolt-on. The hope is that needs canin future be met at a neighbourhood level,with some specialist resources retaining acity-wide focus. There does not appear tobe any independent evaluation of thestrategy.‣ Sheffield Community Portraits4.35 Community Portraits is a project tomeasure how suitable neighbourhoods inSheffield are for the needs of older people,and the intention is to score allneighbourhoods against the outcomesidentified in the DH 2006 white paper, OurHealth, Our Care, Our Say (improvinghealth and emotional wellbeing; improvingquality of life; making a positivecontribution; exercising choice and control;enjoying freedom from discrimination andharassment; economic wellbeing) to whichhas been added personal dignity andrespect, access to services anddemographic need. The first communityportrait was undertaken in the Darnallneighbourhood and included a series offocus groups in the area at which theCommunity Portrait was discussed. Thisapproach can be understood as a lessradical version of Connected Care—oneless likely to challenge existing decisionmakingprocedures.‣ Derby Neighbourhood and Social CareStrategy4.34 Derby’s strategy is based upon aneighbourhood mapping exercise whichcharts the correlation between areas ofmultiple deprivation and levels of socialcare need (Derby 2007). One or twoneighbourhoods were found to account forhigh proportions of children on theprotection register, and for thoseaccessing adult social care support. Thisapproach is seen as an alternative to thetraditional city-wide needs-led modelbased upon individual needs assessmentand pre-judged eligibility criteria, rather‘Only a footstep away’? 194.36 On the basis of the communityportraits, the Sheffield strategy is torefocus neighbourhood delivery across thecity to change services from supporting asmall number of people with highdependency, to early intervention andsupport to larger numbers (Sheffield 2007).This has workforce implications, notablythe development of 16 communitycaseworkers (to act as the case-finding‘eyes and ears’ of their neighbourhoods)and the creation of neighbourhood-basedmulti-disciplinary teams to provide a rapidresponse service and to target people in(or at risk of entering) residential andnursing homes. The Sheffield strategy
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