Martin is recovering from a stroke. He now needs help with activities like dressing, washing, shopping and cooking. Some activities like going to work and driving are right off the agenda. His mobility and communication are impaired and at times he feels useless. But worst for Martin, he feels he is no longer the husband, father, grandfather, friend and colleague he used to be. These were the roles that defined his life and, more than anything, he wants to be restored to those roles. For Martin these roles were characterised by what he could do, plan and decide together with one or more other people. They weren’t about deciding things for himself, although, clearly, that is important to him, but about sharing in decisions and sustaining the rewarding relationships that each role brought.
Understanding Martin’s needs starts with an appreciation of the roles and relationships that make up his life. Meeting his needs calls for attention to what can be done to repair and restore those roles and relationships. It is the same for all the people who care for and support him. Assessments and interventions by the local authority, should be carried out in that social context. This requires us to think about what Martin and his wife and/or his children and/or his friends do together and how their lives together can be supported.
Unfortunately, the Care and Support Bill and the draft eligibility criteria regulations create tight compartments in which separate needs can be assessed: Martin’s and those of his ‘carer’. We assess one lot of needs then we assess another and in each instance we go on to determine whether those needs call for some kind and level of support. Needs and family members are segmented. The idea of two or more people sharing a common need in a family managing with illness or impairment jars.
The draft eligibility criteria regulations do make reference to a person’s or a carer’s “need to support or maintain family or other personal relationships”. But this is to determine what support might be offered to a person, not to a couple or to the family as a whole. This need in particular is a shared need and the solution is also shared among two or more people. Need and accomplishment in the legislative framework are seen as facets of an individual’s life. In the real world they are also facets of the lives of couples, families and groups.
In their comments on the draft minimum eligibility threshold for adult care and support the LGA and ADASS complain that the draft eligibility regulations “are very much based on a deficit model of care as opposed to the asset based approach outlined in the White Paper whereby the individual’s aspirations are valued and considered alongside the full range of support available from the community (including friends and family).” But they give us only hints of what such an asset based approach might look like. They also overlook that the ‘individual’s aspirations’ might also be aspirations that are shared with family and friends.
LGA and ADASS go on to suggest “Our starting point should be designing services based on the personalisation model and providing much greater emphasis on changing the individual’s journey through the system .. For those people who need more support we need a clear outcomes-based approach which builds on their own abilities.” For many people and families it is a shared journey. What they have lost through impairment or illness, and what they want to recover and restore are all too clear. Among other things, they want the local authority to work with them to make progress, as a couple, or as a family, or as friends until what they are able to do together allows them to regain rewarding roles and relationships. This is far more than doing a chunk of work with the ‘service user’ and then another chunk with the ‘carer’.
To be fair, Putting People First and earlier Fair Access guidance does point to the importance of sustaining the family unit. Most trained social workers will need no reminding of this. However, the legislation and eligibility criteria do not help front-line staff to think or work in terms of what works for the family group or the social network. The Care and Support Bill requires assessments to take account of the outcomes which the adult at the centre of the process and the carer might each wish to achieve in day-to-day life. Encouragement is needed for staff to work with people on shared outcomes:
- “Together, we want to take our grandchildren shopping.”
- “We want to help everyone in the family to be able to communicate, converse and enjoy each other’s company.”
- “Martin and his friend will need support to keep their taxi company going.”
- “We want to continue with our ambition to become foster parents.”
- “We think a jacuzzi will be good fun for everyone.”
In (physical) health care it is easier to compartmentalise need: there are individual bits that need repairing. In social care the ‘bits’ are often shared among two or more people. This calls for a different (social and interpersonal) concept of need and a different approach to eligibility.