It’s widely accepted that social care as currently funded and constituted, is facing unprecedented challenge. Budgets are falling at such a pace that the Association of Directors of Adult Social Services and other bodies have declared the situation a care funding crisis. The overall sector has shrunk by 7% in the past two years, with further contraction to come. This is despite demographic pressures suggesting a need for the sector size to travel in the opposite direction.
At the same time, many of the care models and approaches that we have traditionally known are coming under greater scrutiny. Whether scrutiny is around concerns over expansion of, and quality offered by 15-minute homecare packages, or more fundamental questions about the nature, suitability and accountability of large scale, and increasingly discredited institution-based approaches, following Winterbourne View and the death of Connor Sparrowhawk and others in long-term NHS care.
It’s also accepted that the traditionally separate worlds of the NHS and social care need to integrate. They need to join up and talk to each other (sometimes literally), if progress is to be made. This is not just in terms of achieving the savings that the funding climate demands, but more importantly, in achieving improved outcomes for individuals and reducing pressures on services.
Meeting the challenge
This challenge is at the heart of our newly-announced, NHS England-funded project to propel the Shared Lives model of care into mainstream health service thinking.
Shared Lives isn’t a new idea; around 13,000 people across the UK choose to live in, or use Shared Lives. However, it is innovative, growing and a tried and trusted approach to supporting people to live good lives, often at a fraction of the cost of residential or institutional-based care. It even has the potential to support up to 37,000 people through a targeted expansion programme. This could include thousands of older people, and those with dementia and mental health support needs.
Shared Lives and health
Although Shared Lives is most often seen as a social care provider, people using Shared Lives frequently find a positive, and sometimes quite dramatic, improvement in their health. More Shared Lives schemes are working in partnership with clinical commissioning groups, health and wellbeing boards and mental health trusts to develop and enable the people using Shared Lives, not just to live good lives, but healthier lives.
Last month, NHS England launched a £1.75m investment in Shared Lives to help more people to be cared for in a home, not a hospital. Shared Lives carers go through a rigorous approval process before being matched with someone who has support needs and who either visits their chosen Shared Lives carer regularly, or moves in with them and lives for a short or extended period as part of the Shared Lives carer’s household in the community.
People using the scheme may have learning disabilities, dementia, mental health conditions or other needs. Many have complex combinations of health and social care support needs; which more traditional health services find challenging to meet.
Shared Lives has a 40-year history as a local authority-commissioned, social care option, but this new development reflects the increasing evidence of health outcomes. A recent survey of Shared Lives carers showed that 87% believed their support had improved the mental health of participants, and 75% had received positive feedback from an NHS professional about the effect of their support.
The future of Shared Lives
The new investment from NHS England will mean funding and support is being made available to clinical commissioning groups to enable:
- People with learning disabilities to move out of medical institutions into ordinary family homes.
- People recovering from strokes and other health crises to receive their step-down care in a Shared Lives household.
- Live-in mental health support including acute support as an alternative to hospital-based treatment.
- Dementia support including day support and short breaks for family carers.
It’s an exciting new path for Shared Lives – and we believe it may be the first of its kind in the world. Following April’s launch, we received a significant amount of interest, and further detail was released as clinical commissioning groups were asked to express a formal interest in becoming one of the six to ten pilot areas, either as a new Care Quality Commission-regulated Shared Lives scheme or driving the expansion of an existing scheme with a specific healthcare or NHS focus.
Clinical commissioning groups are being asked to match-fund the new development and will recoup their investments in the savings they will make. Shared Lives is cheaper than other forms of care: the cost for an individual with mild to moderate learning difficulties to use Shared Lives, instead of another form of regulated care, could be on average £26,000 cheaper per year. This is around £8,000 cheaper for people with mental health conditions.
Much higher cost reductions can occur when people with learning disabilities and additional, complex needs move from expensive, medical or out-of-area services into Shared Lives. The cost comparison between Shared Lives, typically costing £250 to £450 per week for a live-in arrangement, and a hospital stay, is also more favourable, especially for types of care less-associated with Shared Lives, like acute mental health care. These figures are cash savings and do not include any additional monies or efficiencies, which often come with a Shared Lives match.
This cost-effectiveness stems from the careful recruitment and matching process, the backup of an established Care Quality Commission regulatory framework, and the close relationships which form between people and their Shared Lives carers. These Shared Lives carers have the time and space to get to know, not only what an individual needs, but also what they may be capable of doing for themselves.
Simon Stevens, Chief Executive of NHS England said, ‘Whether helping someone with a learning disability to build a full life with a network of friends and family, or enabling an older person to recover from an operation in the peace and quiet of a familiar environment – people naturally value care and support in a loving family home. That’s why Shared Lives is an example of the kind of community and people-centred approach which needs to play a much bigger part in the NHS of the future.’
We are expecting first responses to the Expression of Interest at the end of May, with areas chosen shortly afterwards and announced in the Summer.
Shared lives, real lives
To put Shared Lives into context, here’s James’ story. James (not his real name), grew up with his mother, who has a number of personal challenges, and his disabled brother.
James developed renal failure and underwent a kidney transplant aged ten. He requires a specialist diet and medication, alongside regular dialysis. He spent the latter part of his childhood in foster care, then moved into an independent flat with a small support package. However, at this time, both his mental and physical health deteriorated and he misused substances, stopped medication and suffered serious renal failure. James became homeless and when he was referred to a rural Shared Lives scheme; he was thin and frail, feeling very alone and overwhelmed, unable to contemplate a future.
James moved in with Shared Lives carers, Fred and Joan, who have a wide experience of working with people with mental health difficulties. Support with diet, health and fluid intake led to James regaining weight and thinking more positively.
When James suffered a life-threatening infection, Joan and Fred ensured that he gained rapid medical attention and helped James work with health professionals and make informed decisions and choices about his in-patient and post-discharge care. James is now planning for his future, whilst the arrangement costs the NHS £275 per week.
Many other Shared Lives carers told us how their support had reduced reliance on primary and acute services, identified misdiagnoses, or challenged unnecessary medical interventions.
Easing the burden
Shared Lives is cementing its place in the sector where new models of care need to be explored. It fits well alongside more traditional forms of health and social care and can help to ease the financial burden on the sectors. The investment in the future of Shared Lives has the potential to offer another option for people in need of health and/or social care services and can help to improve lives too.
You can see more about the project, and details of how to apply if you are an interested clinical commissioning group or NHS trust or scheme, at www.sharedlivesplus.org.uk/health
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