Team Up Derbyshire is beginning to transform the way that we care for our housebound population. Through pioneering work in our local primary care networks (groups of GP practices working together), new services such as home visiting and community GPs are being set up, providing the care and support that people need in the most appropriate setting.
As Team Up momentum gathers pace, we are starting to consider not only how we can best roll-out the new services, but also embrace new ways of working, adopting a change in mindset in how we provide the care and support required for local people. This is being talked about as the ‘Team Up evolution’ or ‘Team Up 2.0’ and a core part of this evolving strategy, is a shift to supporting local people with a strengths-based approach. Strengths-based working attempts to see ‘what is right with people’ rather than ‘what is wrong with them’. It seeks to better understand the individual and their own specific needs and wishes rather than imposing a generic service offer upon them.
An example of where a strengths-based approach has been carried out in practice in Derby for a number of years is the work of Local Area Co-ordinators (LACs). We will focus here on the LAC service in the city although there is a similar offer in the county through Derbyshire’s Health and Wellbeing team.
The evaluation report of the LACs in Derby defines this as an approach which:
Helps communities to become inclusive, welcoming and self-supporting places
Supports people to stay strong and prevents a need for service intervention by building on personal strengths and by finding natural support through local relationships
Supports people facing crisis to get a person-centred service within the context of a supported community network around them
Helps public services to transform so that they are integrated, person-centred and co-produced with communities
Reduces costs to the system as a result of people requiring less assessment, intervention and ongoing care.
There are 17 LACs in place in Derby but new health funding will take the total number of co-ordinators to 19, with one additional post in the city centre and one additional post expanding into the city/county boundary.
Local Area Co-ordination does not start with the perspective of identifying the problems that a person has and the services/resources that they need. Instead, it explores the person’s vision of their ‘good life’ and how they (the person) can make it happen. Understanding and celebrating people and how their family, friends, neighbours and community can help is a powerful starting point. Services then complement and support the role of people and community.
In Derby, Local Area Co-ordination began in 2012 as part of the adult social care personalisation programme. To 2019, it is estimated that more than 2,000 Derby residents and their families have been supported actively by the City Council’s Local Area Co-ordination. With a LAC in each of the city’s 17 wards, it is expected that 765 people are supported actively each year.
The people supported by LAC have also tended to reside in areas of comparatively greater deprivation. About 81% of the people supported reside in parts of the city which fall into the 30% most deprived areas of England.
Introductions to LAC come from a wide range of sources, including statutory bodies, schools, the voluntary sector, people themselves and concerned members of the public. However, the majority of introductions come from within health and social care with the reasons for introduction being:
52% of people were introduced to LAC to support their reablement; helping them to regain needed skills, confidence and independence (often following a life-changing event)
12% of people were introduced to prevent them being admitted to hospital
7% of people were supported to prevent/delay the need for them to enter residential care.
The two following case studies, taken from the evaluation report, highlight the amazing ways in which two people have been supported by LACs to get their life back on track.
Case study - Helen’s story
Helen’s husband passed away suddenly in the early 2010s which hit her really hard. She was then admitted to hospital with kidney failure and while there, she experienced heart failure which resulted in her having to have a tracheostomy. She was in hospital for about three months and, when discharged, was forced to leave her job at a local school on medical grounds. She was heartbroken as she had a number of good friends there and loved spending time with the children. Helen quickly found herself lonely and without purpose. She began drinking and became alcohol dependent, drinking a large bottle of vodka most nights.
Helen was introduced to her Local Area Co-ordinator (LAC) by the Care Co-ordinator at her GP surgery, as the community matron had expressed concerns about her. She was experiencing agoraphobia and hardly leaving the house. She was admitted to hospital on a number of occasions as a result of alcohol-related falls and kidney problems; it was taking longer and longer to be discharged each time as she was experiencing the effects of alcohol withdrawal.
The LAC spent time getting to know Helen and helped her think about how she wanted her life to be. They gradually started to go out, initially just into the garden, then eventually to a local group. The “co-ordinator never badgered me” which put Helen at ease. She reflects that if this had been hurried along, she would not have engaged.
The LAC introduced Helen to two local groups. Attending these helped Helen to feel like she had a purpose – she noticed that she would not drink on these evenings as she wanted to make sure she was OK to go. She was meeting people who she could talk to and was gradually getting more and more independent. Life was beginning to feel very different.
The LAC introduced Helen to a new group developed in the area by people from a local church. The aim was to provide a safe space for people to share their experience of loss. Helen was initially hesitant as she does not have a faith, however she soon learned that this was not a problem and she met some wonderful friends. “I went twice and felt like I’d known them for years,” she says. Helen soon felt comfortable enough to share her issues with alcohol with the group and found that once she had, others too were able to share their difficulties.
Shortly after, the LAC introduced Helen to Dan, another local resident, and they began attending AA groups together. They found the support they could give each other invaluable. Helen still attends these groups now and is able to be completely honest with herself and others about her relationship with alcohol. Helen has now been completely sober for 10 months and says she does not feel even remotely tempted to drink again.
Helen’s life is now completely different to how it was four years ago. “Life is wonderful – I have a new lease of life.” Back then, she was in poor health, alcohol dependent, never left the house and was on the verge of going into an extra care facility. Today, Helen is out every day with her friends. She goes on holidays with those she met at the grief group and they now meet at her house every week. She is able to do her own shopping, she drives again and is healthier and more independent than she has been for a long time.
Helen can also see the difference in her relationships. People no longer feel the need to ring-up to check on her, but rather they call her to catch-up and enjoy conversation. She no longer worries about what she has said as she used to when drinking. Relationships now feel more equal with her loved ones as she is able to offer them support rather than just being the recipient of support.
Comments