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29 Jul 2011
John Adams, VODG general secretary

Beyond Winterbourne: a blueprint for success in social care

What do you get if you combine individualised support (or “person-centred planning”) trustworthy, multi-agency professionals, creative and flexible thinking and strong leadership?

John AdamsWell, not only do you boost the chances of achieving high quality care for vulnerable people and get better value for money but, as the recent CQC report outlined in detail, you end up with the polar opposite of the Winterbourne View unit near Bristol.

The shocking failures and breakdown in care support for those with learning disabilities were exposed in the Panorama documentary last month. While we have film-makers to thank for revealing the worst possible practice in our sector, it meant that yet again, adult social care hit the headlines for all the wrong reasons.

A recent Guardian round-table event held in association with the VODG explored what has to be done to ensure people with learning disabilities have access to person-centred support and local services which meet their individual need.

(Download The Guardian Article: 'The right line for social care' (PDF 173Kb))

Those of us who attended were impressed, for example, with the story of Joe. A young man whose quality of life and prospects were transformed thanks to creative commissioning from Joe’s local authority and outstanding support from Macintyre and the bespoke support package developed through its No Limits service.

The VODG/Guardian event also outlined the key elements in delivering successful support for vulnerable people.

With the right package of care and support, people with learning disabilities can often live largely ordinary lives in their own homes.Firstly, it is crucial that the person receiving support must be central to the planning process; we need to listen to them and be willing to learn and change our assumptions. It’s not about what we about what we think people need, but knowing what they actually want. People with learning disabilities, as one participant told the round-table event, can feel they're on something of a conveyor belt of care rather than feeling as if they're at the heart of the process.

And, as the example of Joe demonstrates, the relationship between commissioner, provider and individual is critical if you want to design creative and positive solutions. This can result in not just a win-win situation, but a win-win-win. The commissioner wins because of lower costs. The individual wins because he or she has been listened to and has a support plan based on their desired outcomes. The provider wins because they are doing what is right - offering support that empowers people.

Of course this doesn't happen overnight, trust has to be built up, based on transparency, flexibility and equitable partnership. This kind of working achieves better outcomes, often at a lower cost as highlighted in VODG’s recent report Gain without Pain.

Vision and leadership are also crucial, as is continuity when it comes to the key players. We need to start planning much earlier – particularly for transition from children's to adult's services – creative solutions don't simply drop out of the sky, but have to be put together like a complex jigsaw puzzle. Good communication is essential.

While a plethora of literature and guidance describes the ingredients of good commissioning, transition planning, and so on, the sector still doesn’t often get it right. Take, for example, the BMA guidance commissioned by the Department of Health and issued last week for doctors who suspect vulnerable adults are being abused or neglected. The guidance includes information on identifying abusers and healthcare failures and reporting poor performance by health professionals. While the onus on minimizing risk is absolutely necessary, it must go hand in hand with spreading good practice. We recognise good practice, but don't seem to be able to easily replicate it.

Replicating good practice has something to do with the skills and leadership qualities of individual players and something to do with local structures and mechanisms (like pooled budgets). But it has much more to do with the culture of the organisations involved and their willingness to look afresh at what works and what doesn't.

Each case and each person is different, but the path to successful support will be easier to travel if partners share a common understanding about everything from cost structures to involving service users in the planning process and recognizing that fair negotiation processes builds relationships and enhances service design and delivery. It is these sorts of issues that will help commissioners and providers create trust and mutual respect and achieve a fair balance of financial risk.

We all know about poor quality and bad practice, we have the Winterbourne View case to thank for that. Sometimes this is very expensive in monetary terms – the average fee per person at Winterbourne View was around £3,500a week - but it’s always expensive in human terms. Wasted opportunities and wasted, often unhappy, lives.

Winterbourne was a terrifying lapse in standards and has thrown up several enormous challenges to our sector. But I'm confident that the aim of the majority of us in social care is to ensure positive outcomes for service users, through the effective use of resources and recognising providers as equal partners in delivery. What happened in Bristol need not overshadow some of the excellent practice that exists; let’s lead by example, disseminate our good practice and prove that Winterbourne is not a byword for social care.

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