How local area coordination may solve the financial malaise engulfing adult social care

By Brian Frisby

Local area coordination began in Derby three years ago as an attempt to understand how the council could meaningfully support citizens to build on, build up or even establish for the first time their own social capital, based on relationships and connections with family, neighbourhood and the wider community.

It involves practitioners – known as local area coordinators – working with people in need to signpost them to local solutions, not in a ‘case finding’ sense, but by supporting and sometimes challenging them to draw upon their wider family network and connecting them to sources of support that are already freely available.

Australian influence

We committed to faithfully repeating the methodology of local area coordination developed in Australia that had demonstrated evidence of positive outcomes for citizens and savings to the public purse.

In doing so, we set out to:

• Work out how to begin to move on from managing the supply of social care in the area towards managing demand.
• Find out how we might reform the front end of the service, where citizens make contact with each other.
• Connect service ‘silos’ and reduce duplication.
• Support communities to be and stay strong.

The development of local area coordination in Derby was never a ‘pilot’ project, but the first step of a journey – the final destination of which we could not know and indeed, had we attempted to define could well have restricted opportunities that we may never dared to anticipate.

Co-production and community development

This action learning approach was underpinned by a commitment to co-production with people living in the two wards where we had decided to commence and to establishing partnerships at the local level – both intended to drive a ‘bottom-up’ approach.

We saw asset-based community development – where communities come together to identify their assets and match them to people who have relevant needs – as being complementary to local area coordination. So we brought in Cormac Russell – a leading proponent of asset-based community development – to work directly with residents within one of the localities. He taught the group how to undertake a community asset survey of their ward, which they went on to do.

The survey found people who wanted to play a more active part in their community and facilitated many introductions to people who were in need of support. The group went on to form the Alvaston Residents Association, which now plays an active role in identifying needs, assets and solutions to issues that have been identified by local people.

We engaged our local university to evaluate the work, to test out whether local area coordination was transferable from Australia to Derby, what benefits it had for citizens, how we might begin to reform the front end of the adult social care system and what financial benefits there may be.

Financial savings difficult to prove

The latter is often the benchmark for success with business cases focusing upon financial savings as opposed to other social benefits. Yet the financial savings produced by diverting people from the system are notoriously difficult to demonstrate.

The University of Derby evaluation delivered entirely predictable results – that implemented according to its core values, principles and methodology, local area coordination produces the same outcomes for people in a city such as Derby as it does in rural outback Western Australia.

Over a period of 10-12 months, working with approximately 50 people, the evaluation estimated a £800,000 saving to the health and social care economy as a result of people’s use of the formal system being delayed or diverted entirely. The findings were used to produce a business case.

However, what proved to be far more persuasive in winning over the hearts and minds of politicians, board members and executives within the local authority and the NHS (commissioners and providers) was the qualitative data that the programme was producing. Often, customer stories, case studies and narratives are dismissed as less value than quantitative financial information.

Powerful stories

Yet it was the powerful accounts of the way in which local area coordinators had been introduced, built relationships, established trust, worked to the person’s strengths and aspirations and built connections with family members and other citizensto create simple, person-centred and inclusive solutions that convinced strategic resource allocators of the need to invest.

Putting it simply, sharing the learning grabbed people’s attention. We used this to cultivate conversations with key colleagues in adult social care and in the NHS about the potential role that local area coordination might play in a reformed system. In the summer of 2013 we began a review of assessment, enablement and support planning within the council and shared the learning about local area coordination with staff and partners, with two unexpected outcomes.

Unexpected outcomes

First, clinical commissioning group colleagues encouraged us to be bold in our thinking about reshaping the system. They challenged our view that a wider extension of local area coordination was a ‘leap of faith’ – and asserted that with the results of the evaluation it was much more a ‘leap of fact.’

Second, in the comprehensive consultation with our staff about the future shape of their service, they strongly endorsed the expansion of local area coordination – making posts part of the establishment, in place of social work posts.

As a result, the original two grant funded posts, plus two others, have been part of the assessment, enablement and support planning service since April 2014 – funded from the base staffing budget. A further three posts have been funded by the CCG from April 2014 with another three posts being recruited this month.

Ten staff across the city, working as part of virtual, multi-disciplinary community support teams with clusters of GP practices to avoid hospital admissions and facilitate returns home. The role of the local area coordinators in these teams is to shape a connected approach to integration and empower strong, inclusive & healthy communities.

Keys to success

Key to the success in developing our strategic approach to local area coordination has been developing the role of senior leaders alongside operational management. Over the past year a group of senior managers from adult social care, the CCG, NHS providers, acute hospitals, special education, public health and neighbourhoods has been nurtured and developed. This is not a hierarchical relationship, because the senior managers are not the experts, but a more clearly defined role in learning about the work, thinking through the strategic connections and opportunities for system wide innovation.

The current unprecedented financial and integration challenges are making the space for creative solutions where the risks associated with innovation are lessened when compared to the risk of just doing more of the same.

Doing nothing more of a risk

We are facing an unprecedented financial burning platform. The typical solutions to efficiency won’t deliver the saving we need – they’ll just salami slice to the point where we ‘fall over.’ In these circumstances it’s more of a risk to do nothing or to salami slice than to innovate with things that may be previously untried and untested. The challenge remains: how do we reform the front end of the system in a way that delays or avoids people needing to come to paid services and keeps those who do to a minimum by squeezing the most out of the universal offer, and also supports people to build on and build up their social capital, shifting resources from the back to the front end?

Local area coordination, done well, has demonstrated the ability to do this in Australia and now in the UK. It may well be the closest thing to a panacea that we will see – but it’s not an overnight solution.

Brian Frisby is a registered social worker, director of prevention, personalisation and professional standards at Derby City Council and a founding member of the local area coordination network. This is an edited version of a piece first published in the June edition of the network’s blog, which will also form part of a forthcoming report on local area coordination by the Centre for Welfare Reform.