Local Area Coordination in England
Samantha Clark (Director Inclusion North) and Ralph Broad (Director Inclusive Neighbourhoods)
October 2011
Introduction
Local Area Co-ordination, (LAC), is an innovative approach to supporting people who are vulnerable through age, frailty, disability or mental health issues achieve their vision for a good life, to support people to contribute to their communities and to strengthen the capacity of communities to welcome and include people.
Local Area Coordination is built on the assumption that people who may be vulnerable due to age, disability or mental health needs are not just “passive recipients” of social and health care, but have expertise, gifts, strengths that can help them achieve their vision for a good life, contribute to their local communities and “maximise the impact of resources” (Bartnik, 2008).
LAC also promotes cultural change and contributes to, and drives reform of, the existing service system, making services more personal, flexible, accountable and efficient.
The essence of LAC makes social care services and supports more personal, local, flexible and accountable, and thereby to build and strengthen informal support and community self sufficiency.
It aims to move the “front end” of the service system/primary source of support from assessment, money and services to prevention, helping people to stay strong and supporting practical solutions.
This paper reflects learning from the past 23 years (see Further Reading) in Western Australia, other Australian states, Scotland and emerging developments in England. We would like to express our thanks to Eddie Bartnik and the Disability Services Commission in Western Australia for supporting the development of Local Area Coordination in England.
What is Local Area Coordination?
Local Area Co-ordination was originally developed in Western Australia in 1988 to “build individual, family and community self sufficiency so that individuals with intellectual disability can choose to live with their families, or in their local community without compromising their quality of life”. It has a strong person centred value base and works with individuals and families in communities.
LAC has subsequently developed across Australia and other countries (including Scotland as a key recommendation of “The Same as You?”, Scottish Executive 2000) and is now starting in a number of areas in England, including Middlesbrough, Cumbria, Stroud and Derby City, supporting people vulnerable to age, disability, sensory impairments and mental health needs.
It has also most recently also been developed in New Zealand as a key part of national service reforms (see press release, Ryall, T. 2011)
In Western Australia, Local Area Coordination was an example of a driver of whole system reform including the development of alternative, “asset/strength based”, cost effective community living support models (Bartnik, 2010)
LAC formed a central role in re thinking the purpose of services. Rather than asking “what services or money do you need?” it asks “what is your vision your vision for a good life and what are the range of ways you can get there?”
LAC has been both influenced by and contributed to the development of Strength/Asset-Based Community Development thinking and practice over the last 2 decades – which is now impacting upon the unfolding of the Health and Well-Being, Joint Strategic Needs Assessments, Localism and social care reform agendas.
It is built on the principle that the purpose of social care reform is to strengthen informal supports and community self sufficiency and to make services more personal, flexible and accountable (Bartnik, 2008).
It aims to actively form partnerships with individuals, families, co-producers and local communities to promote self sufficiency and local solutions to problems. It also forms strong partnerships with formal services and professionals.
In response to the complexities of the system, LAC combines/replaces a range of existing roles and delivers these in a very local, personal and flexible way.
It is underpinned by the following principles
The Ten Principles
The principles below guide the development and operation of LAC:
1. As citizens, people vulnerable due to age, disabilities or mental health needs have the same rights and responsibilities as all other people to participate in and contribute to the life of the community.
2. People vulnerable due to age, disability or mental health needs and/or families supporting the person are best placed to determine their own goals, and to plan for the future either independently, as a family, or supported by advocates of their choice.
3. Families, friends and personal networks are the foundations of a rich and valued life in the community.
4. People vulnerable due to age, disabilities or mental health needs and their families have natural authority and are best placed to be their most powerful and enduring leaders, decision makers and advocates.
5. Access to information that is timely, accurate and available in appropriate formats enables people to make appropriate decisions and to gain more control over their life.
6. Communities are enriched by the inclusion and participation of people vulnerable due to age, disabilities or mental health needs and these communities are the most important way of providing friendship, support and a meaningful life to people and/or their families and carers.
7. The lives of people vulnerable due to age, disabilities or mental health needs and/or their families and carers are enhanced when they can determine their preferred supports and services and control the required resources, to the extent that they desire.
8. Services and supports provided through Local Area Coordination complement and support the primary role of families, carers and communities in achieving a good life for people vulnerable due to age, disabilities or mental health needs. These services and supports should not take over or exclude the natural networks that already exist or could be developed.
9. Partnerships between individuals, families and carers, communities, governments, service providers and the business sector are vital in meeting the needs of people vulnerable due to age, disabilities or mental health needs.
10. People vulnerable due to age, disabilities or mental health needs have a life-long capacity for learning, development and contribution.
Adapted from Disability Services Commission Western Australia, 2004.
How Does it Work?
LAC is an eclectic combination of approaches, delivered in a unique and connected sequence.
LACs support 50-65 individuals and their families and are based in their local communities as a local, accessible, single point of contact for people of all ages who may be vulnerable due to age, disability or mental health needs. This enables the support provided by LACs to be personalised, flexible and responsive, within the context of their family and community life.
They take time to get to know and build positive, trusting relationships with individuals, families and local communities and develop a more personal relationship with a wide range of vulnerable people and their families.
It combines a range of existing, often disconnected roles in a single, local point of contact supporting children and adults within their local community and is intentionally designed to
· Support people to identify their vision for a good life and their plans for getting there
· Understand and utilise personal, family and community gifts, strengths and interests - Support people to stay strong
· Access accurate, timely and relevant information from a variety of sources – choice and control
· Support people to identify and develop personal networks
· Support people to have a voice – self advocacy, advocating alongside people or advocate for people
· Support people to develop practical (non service) responses to needs
· Build partnerships with and between individuals, families, communities and services
· Support people to access and control resources or services where this is needed or eligible
· Link people with existing community resources
· Participate in and contribute to building inclusive communities through partnerships with local businesses, community, voluntary and third sector organisations
· Identify gaps in community opportunities and form partnerships to actively develop local communities and resources – community building
· Promote opportunities for contribution and leadership
Local Area Coordination in England
Following a number of VPST workshops in the north east, arranged by Paul Davies and led by Eddie Bartnik (who first developed LAC in Western Australia), development of Local Area Coordination started in Middlesbrough in 2010 with support from Ralph Broad and Inclusion North. This involved working in partnership to build understanding of LAC, effectively design, develop and implement the approach in the context of local needs and personalisation/reform agendas, share the vision at individual/family/community and systems levels and then get started in 2 local communities.
The early “formative” evaluation of the Middlesbrough programme is now available (September 2011).
This evaluation showed very encouraging early outcomes, with recommendations for ongoing improvement and for expansion across the area. Follow the links to Local Area Coordination on the Middlesbrough Council website or via
http://www.middlesbrough.gov.uk/ccm/navigation/health-and-social-care/local-area-coordination
Derby City and Stroud are now also in the early stages of discussion, design and development of Local Area Coordination, with a rapidly increasing number local authority areas starting to get involved.
Learning from elsewhere
The development of Local Area Coordination in England is paying great attention to lessons from developments in Scotland and internationally. Where LAC has been fully implemented as designed, outcomes have been consistently strong. Where partly implemented or a “cherry picking” of parts of the approach, outcomes have been less predictable.
It highlights the importance of
· Ongoing attention to quality, contribution and core principles
· Clarity and consistency in implementation of core values, principles and approaches – when you “cherry pick” parts of the approach, outcomes are less predictable
· A clear LAC policy and operating “framework” – understand the approach, stay on track, learn, improve, be accountable.
· Attention needs to be taken to ensure that LAC remains relevant for people across diverse cultural and linguistic backgrounds
· A clear communication plan to engage and maintain links with individuals/families/communities, statutory services and 3rd Sector
· Careful attention to recruitment, selection, support and development of LACs over time.
LACs come from a range of backgrounds
· Being local, accessible – building partnerships, nurturing existing local resources and working together to develop local, personal, flexible responses to needs
· All ages – intentionally developing a long term relationship, connecting journeys across service types
· Supporting 50-65 people in their local community.
· Leadership at the individual/family, community and senior levels in social care and health
· Careful attention to where LAC is embedded or managed in the service system/structure - to maximise effectiveness, influence and contribution to reform and partnership
· LAC forming the “front end” of the service system – prevention, capacity building, strength based approaches to supporting people to achieve their vision for a good life
· Opportunities for LAC/strength based approaches to contribute to re imagining the role and expected outcomes of specialist services and funded provider services.
“If LAC is at the “front end” focusing on practical responses, building individual/family/community capacity, what could formal services look like in the future?”
· Developing partnerships across service types, paying particular attention to people in life transitions – simplifying the service system
· The need for strong, ongoing links with statutory services and shared understanding of roles, expectations and responsibilities, in particular with reference to safeguarding issues
Example – Scottish Executive, 2008. p.20-21What makes local area coordination effective and what limits its success?
The 2005 national evaluation of the implementation of local area coordination in Scotland concluded by stating: ‘In order for LAC to prosper and flourish across Scotland, and continue with much needed support to individuals and families, it must be consistent, resourced and valued.’
Key factors identified by this evaluation as impacting on the success of local area coordination are:
· The commitment of senior managers.
· A clear definition and understanding of the role by local area coordinators themselves, their managers, other local authority staff, service providers and individuals and families.
· The extent of confusion and/or tension between the local area coordinators role and that of social work/ care management.
· The degree to which local area coordinators are equipped (i.e. suitable office facilities), trained, remunerated and empowered to do the job.
· Local area coordinators’ values and commitment to inclusiveness, empowerment and acknowledgement of the natural authority of families, was identified to be fundamental to the success of local area coordination.
· The extent to which local area coordinators have time to build relationships with individuals and families to help them to identify their own needs and work toward change in their lives. This is dependent on local area coordinators having manageable numbers of people to work with (The same as you? recommendation of 50) and how many local area coordinator posts there are in each local authority area.
· The extent to which local area coordinators are able to concentrate on their core functions rather than being asked to carry out a diverse range of task.
· The geographical and demographic constraints on the local area coordination role – they may not have a remit to work in certain communities or with all age groups and impairments/needs.
· Community capacity building success may be linked to the degree to which communities are welcoming, whether the local area coordinator has a strategic base in the area and their previous knowledge of the locality and/or their community development background.
Why Do We Need Reform? – Unintended Consequences of the System
Over many years, the health and social care system has become very complicated (for people/families) and has focused predominantly on services and money for solutions.
This has resulted in significant “unintended consequences” including
· Encouragement of public dependency on services and money
· The professionalisation of day to day activities associated with caring for each other – replacing relationship-based and freely given care/support with systematised and paid-for services
· A culture of waiting/competing for funding and services, rather than developing local solutions and self sufficiency - People being “fitted into services”
· Subsequent reductions in community capacity/resources
· Increasing exclusion and isolation for people