About twelve years ago, I was involved in discussions with a local authority and clinical commissioning group to agree good support for my dad, who had dementia.
A day centre was the only support on offer. No doubt, this provision worked for some, and still does, but it failed spectacularly to provide meaningful support for my dad and our family. Not because there was anything wrong with the centre; it just wasn’t what he wanted or needed.
The family implored health and social care colleagues to support him to do things he loved and that had meaning for him, which in his case meant attending festivals and concerts, visiting galleries and going swimming. It seemed we were asking for the impossible.
More than a decade later, what has changed? Can people who access services say that they are living the life they want, and doing the things that are important to them, as independently as possible?
This should be a straightforward outcome, and it’s an outcome that we know to be essential to our wellbeing. Yet, for too many people who require support, it remains very challenging to live the life they want to lead. Making it Real helps organisations overcome these challenges so that the people who are using services are empowered to lead the life that is important to them.
There is no doubting the profound push for transformation across our health and social care system. Think Local Act Personal (TLAP) has always believed that genuine transformation requires new relationships and new conversations. Making it Real provides a framework to develop these and can lead to a more equal power-sharing arrangement, where people acknowledge the expertise of the ‘professionals’ and, similarly, people are recognised as experts in their own life. It can help dissolve the hard border that exists between what the system thinks is needed and what the person knows to be important to them.
How does it work?
Making it Real was first launched some years ago, but has now been radically reframed to take account of the Care Act 2014, with its emphasis on wellbeing, and to reflect the growing importance of personalisation within health.
The framework sets out what good, genuinely personalised care and support looks like from an individual’s perspective. It then illustrates what the workforce can do to change its practice to deliver an approach that is far more person- and community-centred.
It is built around six themes that reflect the most important elements of personalised care and support, such as wellbeing and independence and active and supportive communities. It consists of ‘I’ statements that describe an individual’s perspective and ‘We’ statements that express what organisations should be doing to live up to those expectations and make the ‘I’ statements a reality:
‘I am supported by people who listen carefully so they know what matters to me and how to support me to live the life I want.’
‘We don’t make assumptions about what people can or cannot do and don’t limit or restrict people’s options.’
Making it Real supports the workforce to examine their practice through a different lens. By looking at their current practice against the statements, organisations can identify areas where progress needs to be made.
By using the Making it Real framework – and therefore grounding transformational policy in the reality of people’s lives – organisations can also feel far more confident about any changes they are making.
The approach is relevant for all adults who require support, as well as carers and the people who are supporting them, and works across all settings including community-based support and care homes. Large organisations with multiple branches or homes can get involved individually or as a group. Whilst the context may differ, the common element is that support should be based on what matters most to people in their lives.
Co-production is key
Making it Real has been the most co-produced document I have had the pleasure to be involved in. People with lived experience worked with organisations as equal partners in its development and content.
Over 200 people from across the health, care and housing sector were involved in the new project. People with lived experience, including carers, continue to work with TLAP to support organisations to implement Making it Real.
The framework is fundamentally about people, relationships and conversations, so genuine co-production is key to success.
‘CQC has been privileged to be involved in Making it Real. It is an incredibly useful way to support people in understanding what good and outstanding person-centred care looks like and what they should expect from providers.’
– David James, Care Quality Commission (CQC)
Organisations who have adopted Making it Real have changed their practices and report good outcomes for the people and carers they support.
Manor Community, a provider in Bristol, supports people with mental health issues, learning disabilities and older people. They use the Making it Real ‘I’ statements to identify the extent to which the people they support feel that those statements ring true. They then work together to develop action plans to improve any areas that aren’t meeting expectations.
Shropshire Council has been working with Making it Real for some years. It has set up three local advisory groups in different areas across the county. These are open to people with lived experience and carers, the workforce and volunteers, who want the opportunity to co-design service development. The advisory groups feed into and influence the council’s Making it Real Board, which is chaired by a carer who describes himself as a critical friend to the council. The Chair praises Shropshire Council for its enthusiasm for the Making it Real ideals and its willingness to listen to voices from outside the council.
How can it work for you?
The beauty of Making it Real is its ability to work on a number of levels: individual, operational and strategic.
Individual – Making it Real can be used to generate a really good and meaningful conversation about what matters to people. It takes as its starting point a clear understanding that citizens who require support to live their lives well are not empty vessels but experts in their own lives and have insight and expertise to contribute.
Operational – organisations can use Making it Real in a wide range of ways to inform operational delivery. In particular, it can be a helpful self-assessment tool to identify where an organisation needs to make progress to ensure that it is delivering personalised care and support.
Changes made to operational approaches as a result of using the ‘I’ and ‘We’ statements include developing new recruitment procedures to ensure people who access services have significant involvement in selecting and appointing new staff; embedding the ‘I’ and ‘We’ statements in Service Level Agreements; and using the framework as a key element in contract tender exercises.
Strategic – a number of organisations have established Making it Real boards or advisory groups to ensure that the ‘I’ and ‘We’ statements inform strategies, policy development and plans. Warren Heppolette, Executive Lead, Strategy and System Development at the Greater Manchester Health and Social Care Partnership, says that Making it Real can be used corporately in terms of business planning and for developing targets. He advocates using it for performance setting, and describes it as a much better framework than the dry and bureaucratic frameworks currently used.
At a national level, Making it Real is being used to support the implementation of the Quality Matters framework and conversations are being held with CQC colleagues to explore how Making it Real can support the regulatory framework in future.
Whilst all of these practical changes are positive, underneath the surface, a powerful alchemy is taking place: embracing the principles and philosophy of Making it Real supports a new dynamic, where power is shared and relationships are prioritised over transactions. As Sally Percival, carer and Chair of the National Co-production Advisory Group has asserted, ‘Making it Real is not just another thing for organisations to do. It is a vision, inspiration and a guide that, if used in the way intended, will help people to lead their lives to the fullest.’
‘Making it Real is about helping everyone to have ordinary lives.’
– Dame Phillippa Russell, Carers UK
A long way to go
In 2019, we know that there are excellent examples of innovative approaches that challenge the one size fits all approach, but there is still a long way to go before it becomes genuinely routine. I know Making it Real can help make this shift, and there is really only one rule that must be observed if Making is Real is to be genuinely implemented: it must be co-produced. If this is unfamiliar territory, there are lots of resources on the TLAP website, from top tips to our ladder of co-production.
The ultimate goal must surely be for people who access care and support to be able to say, ‘I can live the life I want and do the things that are important to me as independently as possible.’
About Think Local Act Personal
Think Local Act Personal (TLAP) is a national partnership of over 50 organisations committed to supporting the continued implementation of personalisation and community-based health, care and support. We offer information, web tools and forums to support social care policy and practice. All our events are free to attend and our networks and forums are open to anyone to join.
Want to get involved?
For more information on how different organisations are successfully using Making it Real to improve the quality of their care, watch this short film.
To find out more about Making it Real’s uses and impact, read Kate Sibthorp’s blogs on the Think Local Act Personal website. Kate is a carer, a member of the National Co-production Advisory Group (a team of people with lived experience, families and carers) and a staunch advocate of Making it Real.
Further information on how to become more involved is available on the Making it Real pages of TLAP’s website.
How do you ensure your service is person-centred? Have you used the Making it Real statements successfully? Share your stories and feed-back on this feature by leaving a comment below.