Business Clinic
Partners in Support

It is often said that service development and innovation is easier for larger providers. That truly individualised support is resource-heavy, making it harder for smaller providers to achieve. However, Partners in Support is doing exactly that, whilst remaining deliberately small and local.

Personalised support on a local level

Partners in Support is a small, local supported living provider, set up in Hertfordshire in 2007. It supports people with learning disabilities who have behaviours that challenge. Many of its initial clients came from hospitals or assessment and treatment units.

The organisation was set up in partnership with Hertfordshire County Council and Hertfordshire Partnership NHS Foundation Trust, who supported Martin Nicholas, Partners in Support’s Director, with seed money of £70,000 over two years.

Martin explained how the organisation was established: ‘I was fortunate to visit excellent local services such as Partners for Inclusion and Inclusion Glasgow in Scotland. Having worked for a big charity for 14 years, which had increased its provision significantly over that time, I came to the conclusion that, to be able to give consistent high-quality support to people, there had to be a new way of looking at the development of new services. I decided I wanted to be part of something that was new and innovative in its approach and really focused on the needs of the people at the heart of the organisation.

‘Coincidentally, Hertfordshire County Council was struggling to commission local services for people who required more bespoke support. Over an informal discussion with the service manager of learning disability services, we established a common vision of responsive person-centred support which led to Partners in Support.’

Bucking a trend

Partners in Support’s ethos is ‘To enable people with learning disabilities to determine the life they live and strengthen their community of family and friends’. The organisation supports individuals to lead the lives they choose as independently as possible within their own homes and chosen communities.

Martin explained why he set up Partners in Support as a highly-personalised, local, small-scale organisation. ‘The company was set up in response to a number of trends in learning disability services. These included:

  • The drive to consolidation, which I felt was detrimental to providing truly consistent, person-centred services.
  • The fact that people with complex needs were still in assessment and treatment units or services that didn’t support them to be part of their local community.
  • A growth in companies delivering low quality outcomes and paying support staff low salaries.
  • An increased use of agency staff and its impact on consistency of support.’

Innovative commissioning

This was in 2007. Current policy is still driving the need for bespoke, community-based, local support. The Government’s recent Transforming Care programme for learning disability services plans to reduce the number of inpatient beds by up to 50% nationally. Central to the progress over the next three years will be new, high-quality, community-based services. Local areas will be able to design bespoke services with those who use them. However, this needs forward-thinking commissioners.

Valuing People Now: a new three-year strategy for people with learning disabilities ‘Making it happen for everyone’ highlighted the innovative commissioning involved in setting up Partners in Support. ‘In Hertfordshire, the local authority and Hertfordshire Partnership NHS Foundation Trust sponsored the development of a new not-for-profit organisation to work in the county. With seed funding from an innovation grant over two years, Partners in Support was created…Working specifically with individuals who were seen to challenge services, Partners in Support has been developing individualised support solutions based on individuals’ person-centred plans, working closely with individuals and their families. As a result, people have been supported to move near to their families into accommodation of their choosing. Each person has their own team employed to work with them, matching staff with similar interests and fully involving the individual and/or their family in the recruitment process.’

Is small beautiful?

Partners in Support fits with the needs of the time, however, as with any successful model, there can be expectations to expand and replicate.

Partners in Support has no such plans. Martin Nicholas explained, ‘Despite many organisations having great mission statements and values, I believe the larger an organisation gets and the wider geography it covers, the harder it is for that organisation to continue to offer the same consistent, high-quality support.

‘Decision-makers, no matter how skilled, become isolated and further away from the realities on the ground. Positive support is fundamentally about the interaction between the person receiving support and their staff; this requires full and dedicated staff teams, awareness of subtle changes in peoples’ lives and regular interaction with people receiving support and their families. All of which is more challenging the larger you get, as responsibilities become delegated down through many management layers to less experienced managers.

‘We have turned down the opportunity to work with other local authorities because, whilst we would love to support more people to improve their lives, we know this would be at the detriment of the people we currently support. From day one, we have stated it is “Hertfordshire only” and that will never change.’

Outstanding example

To add to the service’s achievements, it achieved Hertfordshire’s first ‘Outstanding’ rating by the Care Quality Commission. The inspectorate highlighted the time spent developing ways to accommodate the changing needs of the people who used the service and the innovative and flexible ways it supports people to progress. The report states, ‘The registered provider was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential…and their support plans and environment adapted and developed to promote their independence.’

Over to the experts…

With policy driving learning disability support towards bespoke, community-based services, is smaller and local a better model for learning disability services? Is it possible for individual providers to replicate Partners in Support’s bespoke model? Or are larger providers more likely to have the resources and economies of scale? 

Encouraging but there is no ‘right’ size

It was encouraging to learn about Partners in Support and its intention to remain small in order to give the very best support. More than 20 years ago, I started a community enterprise, an arts company of performers and artists with learning disabilities. Like Partners in Support, we were supported by imaginative commissioners, received start-up funding and made the decision to stay small. We felt that the ideas and determination of direction of the company, that was being exercised by its ‘members’, would be lost if it grew. As wider arts and community funding that gave us our edge was cut, it became increasingly precarious to only be working with one local authority. I wonder if current funding challenges will mean that the innovative commissioning that has enabled Partners in Support to flourish, will eventually be undermined.

I now work for Real Life Options, which, having started small, has now grown into a much larger organisation. A widely-spread infrastructure means that organisational costs can be more efficient and there are benefits from sharing good practice across the organisation. But it is more of a challenge to be truly local. Empowering staff to be active and creative in supporting people to be a full part of the communities in which they live is essential.

My thoughts are that there is no ‘right’ size. The baseline question has to be whether any organisation, large or small, is enabling people to take a full role as citizens of their local communities. This will never be possible without a revolution in commissioning in every local authority and an end of tendering processes where the final decisions to contract are inevitably made on the cheapest price.

Anthea Sully Head of Public Policy, Real Life Options

The development of equal partnerships is key

At Think Local Act Personal (TLAP), we have seen great examples of genuine personalised activities that run counter to traditional notions of large scale social care support. Indeed, a recent evaluation of micro-based organisations from Birmingham University, concluded that, ‘micro-providers offer more personalised support than larger providers, particularly for home-based care.’ One of our partners, Community Catalysts – set up by the charity, Shared Lives Plus, shows that when organisations take a strengths-based and co-produced approach, it can, ‘harness the talents and imaginations of people in communities and organisations to provide creative solutions to complex social issues.’

While our work with local authorities and partners from health, social care and housing offers us examples that suggest small is beautiful, there are certainly levers in place to support large providers to be as innovative. Mechanisms for this would be the adoption of personal budgets – particularly via direct payments, as well as pooled personal budgets and Individual Service Funds. We know that when the process for getting and managing a personal budget is easy and when the views of recipients are included, people are far more likely to report good outcomes. This was clear in the 3rd National Personal Budget Survey published by In Control, Lancaster University and TLAP last year.

After all, the key ingredient to innovative and successful service development, regardless of resources and economies, is the development of equal partnerships with people who use services, carers and professionals. This co-produced approach will lead to shared solutions that are tailored, cost-effective and increase community capacity.

Lynda Tarpey Director, Think Local Act Personal

Smaller is definitely beautiful

It is pleasing to see what outcomes may be achieved with a collaborative and innovative approach between a small provider, local authority and clinical commissioning group. But therein lies a problem, collaborative and innovative commissioning is geographically patchy, which leaves smaller providers feeling they don’t have the clout to push the agenda.

The Transforming Care programme should be a manna from heaven for small providers dedicated to enabling those with learning disabilities to maximise their potential. In reality, this seems far from the case as commissioners seem to favour (much) larger providers.

There are many advantages in working with a smaller provider. All of our team develop a knowledgeable relationship with the individual and their family support network. We can focus true person-centred support to the real wishes and aspirations of the individual with the input of our in-house occupational therapist developing meaningful therapeutic input and outcomes to help achieve these. The decision-making chain remains localised with empowered managers able to access the support, if required, of the managing director almost instantly. Our support teams have a real opportunity to lead and have a say in how they feel their support should be best utilised.

As with Partners In Support, we value highly the dedicated personal support we can give as a smaller provider. We have a clear pathway through our children’s and adults’ residential services to supported living. This works well with the few commissioners we deal with. Continued development of our services with these commissioners is in our plan and we really hope Transforming Care can become a part of this. But, fundamentally, in my view, small(er) is most definitely beautiful.

John Timbs Managing Director, Lodge Group Care

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