Claire Bruin, Care and Health Improvement Programme's Care and Health Improvement Adviser, and Sam Clark, Chief Executive of Learning Disability England, in conversation discussing the links between the Supporting people with Learning Disabilities to have Better Lives Framework, developed by the Care and Health Improvement Programme, and the Good Lives Framework, developed by Learning Disability England.
Sam Clark, Chief Executive of Learning Disability England and Claire Bruin, Care and Health Improvement Adviser (East of England) of the Care and Health Improvement Programme, sat down to have a conversation about the Good Lives Framework developed by Learning Disability England and the Supporting people with Learning Disabilities to have Better Lives Framework, developed by the Care and Health Improvement Programme.
They wanted to explore how the two frameworks might fit together to support people with a learning disability to live good lives.
Sam Clark The Good Lives Framework – where it came from
We first shared the Good Lives framework in March 2022. It comes from Learning Disability England’s work over a period of years, recognising that lots of our members were wrestling with problems and challenges.
But also, there were green shoots of hope and opportunity. There were glimpses of what really was working for people, so we began to think about how Learning Disability England could use our position as a membership organisation that includes people with learning disabilities and the groups they're part of, (family members and their organisations and what we call paid supporters and their organisations.) This membership means we have this incredibly lucky and privileged position that we see and hear a whole breadth of lived experience, as well as that of organisations from councils to national provider organisations to really small volunteer led activist groups just working in one area. We wanted to help network and connect that opportunity we had to help people. We set out to come together and create something that is coherent and helps clarify where we are now, but also really importantly, seeks to work out where we have heard people want to get to in the future. So that's what our Learning Disability England Good Lives framework says: this is what we hear is happening now, this is what people tell us is important for a good life and these are some of the actions that can be taken to get there.
About Good Lives: Building Change Together
The focus on action is within a rights-based framework. So, we took the United Nations Convention on the Rights of the Persons with Disabilities because one of the things that people with learning disabilities told us was, they wanted this to be embedded for them as citizens and not only as recipients of services, but as people who are active producers in their community. Also, the whole framework is focused on a hope-based model that says, acknowledge what isn't working, look at where we think we need to be and what our solutions are to get there.
So, there are actions in the framework for everybody and anybody in the community. Some that are quite specific for example, that self-advocacy groups can do, and commissioners can do, and national government could do to get us to where we want to be. But it is very much about trying to bring together that collective lived experience and effort for change, almost into an action plan, a policy, or a manifesto for change. So, it is aspirational, and we know some of it will take some big steps. Some of it is work we could do now or practice we could change and some of it will take us some time to get there.
These last few months since we published the framework, we have been finding out if we have the right actions, and what else needs to be in there. So far no one has challenged what is in Good Lives, and in fact many have offered to add more to strengthen it.
Claire Bruin the “Better Lives” Framework
So, the Care and Health Improvement Program (CHIP), that supports councils to improve the services that they deliver and arrange, is a partnership between the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) funded by the Department of Health and Social Care (DHSC). We wanted to do a piece of work to support councils specifically in improving their services for adults with a learning disability.
We were very conscious that councils spend roughly 50% of their adult social care budget on working age adults which mainly will be on people with a learning disability, so we were really keen to develop a tool to support improvement.
We wanted a tool that councils could use themselves that would help them to explore how well they were doing in improving outcomes for people with a learning disability, which is one of the reasons why we've given our framework a rather long title of “Supporting Adults with a Learning Disability to have Better Lives.” So, this is a mouthful, but the focus is on improving outcomes for people and improving people's lives. We call it the “Better Lives framework” for short.
The framework has been developed as a self-evaluation tool and there are six different domains or areas of work that councils need to look at. The process is that the council would bring together people with lived experience, family carers and the partners that they work with, providers, health colleagues, the community and voluntary sector and, of course, their own staff and then work through the three steps in the framework.
The first step is a quick self-evaluation of all six domains, with questions to explore how the council is doing in each domain and what are people's experience of the services delivered and arranged by the council. This would begin to give them a sense of where services could be improved.
Across the six domains, there may be some things that they're doing better at and some things that they're not doing so well at. The conversations that they have through the first step of the process allows the council to decide where they want to put more focus and energy into making the improvements. This leads them into the second step – deciding which domains to look at in more detail to inform the action/development plans that will drive improvement.
When deciding on which domains to look at in more detail, a council won’t necessarily only choose to focus on something that needs to improve. They might also choose to focus on something where they're doing some really good work, and it might not take a lot to improve that even further. So, it would be a bit like you were saying, Sam, that some things within the Good Lives framework could be changed now, but other things are going to take a longer time.
The third step is to use the resources section of the framework to understand what works well and how to make services the best they can be and to use this information in the development of your action/development plan for improvement.
In a similar way to your focus on human rights, Sam, we have some clear principles that underpin our framework that are linked to people's rights. It's around inclusion, equal access, person centred planning, safeguarding and people being safe, and sustainable models of support that can enable people to progress and develop their skills and work towards their aspirations and their ambitions.
It’s worth looking at the new films we have made and easy read that explains all this.
We've seen a council pilot the framework. We've walked alongside them as they were running through step one, the self-evaluation and then deciding on the domains to focus on in more detail. We attended the workshops they set up for this part of the process. They also had surveys for people with lived experience and family carers and for staff and were trying to engage people to get the best-rounded view of where their services were at.
We're particularly keen to make sure that people with lived experience and family carers are very much a part of the process so that the decisions around improvement and the action and development plans that come out of that are co-produced with people as part of this process.
How Better Lives and Good Lives might fit together
Sam Clark: So, in listening to you, I was thinking about the Better Lives framework as a coherent way of looking at the kind of health and social care that focuses on outcomes and a better life and the Good Lives Framework is a challenge to us all, almost to say, how are we doing now? How are we moving to a world where people with learning disabilities are equal citizens, in their lives in every way, so it might be a wider focus? Is that right, Claire? You know, it might be that some of what Good Lives is challenging us all to think about is much broader than the council's responsibility, but the council might want to be a part of that challenge too because they support the overall aims.
Claire Bruin: Yes, I think that you're right there, Sam. And I think what Good Lives has the potential to do is to offer some of the actions that can be taken to make the changes that the whole council, not just adult social care, might identify through the Better Lives framework. So, if they find a particular area that they need to improve on, and it might be housing for example, then I think the Good Lives framework would offer some of those broader challenges to everyone’s thinking. I think it could be quite helpful to have the Good Lives framework alongside the Better Lives framework, whilst the self-evaluation is being done to see what cross references there are and then some of the actions that are suggested in the Good Lives framework maybe the solutions for changes and improvements that a council as a whole needs to make. So, I think they could dovetail really nicely.
Sam Clark: Yes, they could, and I guess the other thing that occurred to me is that Good Lives is saying this is something we all have a responsibility for. So, it might support councils in their conversations with local support providers, but also their local advocacy organisations or other statutory services.
I was thinking as you were talking, I had a conversation yesterday about double beds. About people wanting to be able to have people stay over generally, but also you know, can you have a partner come and stay with you and things like that. Well actually that might be something that a council wants to champion alongside people with learning disability in its area, rather than take complete responsibility for, you understand what I mean? It can change some of its reviewing criteria or its quality or its commissioning, but actually that's something that we need other partners to be picking up and looking at whether their system or their support creates barriers to people having friends stay or a partner stay. Those are the things that can often be personally really important to people that might get lost off our radar otherwise.
Claire Bruin: Yes. And that really is about living your life rather than living a service and the constraints that a service can sometimes put around people’s lives and restricting people's experiences.
Sam Clark: Yes, absolutely, absolutely. But then also I was listening to you I was thinking that the Better Lives framework is a real opportunity for local people to be engaging in a coherent way with the council about what we all think is happening now and where we want to go. So, it gives that broad set of principles and a really positive way to have a conversation about what matters around here.
Claire Bruin: Yes, I think right, Sam. It does frame it for the councils and really gives them an inroad to having constructive conversations with people and interestingly some of the councils that I have spoken to have flagged that they are at the beginning of their co-production journey and are seeking constructive support to move forward on that journey. They are really committed to getting it off the ground but need some support to think through where they are at now and what are the next steps. I had quite a long discussion with them about how the Better Lives framework could be a vehicle to start to engage people and give a reason for bringing people together to have the conversations.
Sam Clark: I'm all for open accountability and creating change together. A huge opportunity. I was just thinking as you were talking about the LGA Magazine – First, for elected members. Recently it ran an article on North Yorkshire Learning Disability Partnership Board. Well, you made me think, as you were talking then, how important something like a Learning Disability Partnership Board can be in helping you engage in those conversations with the whole of the community representatives and different people and have a broad co-productive conversation that is robust but based on partnership. I know lots of people don't call them partnership boards now, but as you were talking about the Better Lives framework, I was thinking gosh, this would be very hard to do without something like that as a network hub.
Claire Bruin: Yes, and I think that over time there's been less and less focus on Valuing People and Valuing People Now. That's kind of language of the past, but actually it is still equally relevant, but the concept of a multi-interest partnership board doesn't have the same prominence.
It's interesting because the Autism Act guidance encourages Autism Partnership Boards. So, I think that has begun to bring partnership boards back on to the agenda. They may have been separate to learning disability partnership boards but some of them may have been linked or merged somehow, and so I think that that may well be prompting conversations about those sorts of structures again.
Sam Clark: Yes, absolutely, and I guess I didn't say when I introduced Good Lives, one of the drivers from Learning Disability England members point of view is this issue of your whole life and inclusion and an ordinary life and all those Valuing People principles are not prominent because policy and investment for some years has been quite dominated by health led policy. And of course, people's good health and supporting people not to go into specialist mental health units is incredibly important, but it's sort of skewed our focus towards hospitals, I think, as a community or a sector, if you want to use that word, but I think actually something like the Better Lives framework and Good Lives can help bring us back to those important prevention principles. Being healthy and having good health support is really important, but actually there are much wider determinants of that as well.
Claire Bruin: And in in the context of the Care and Health Improvement programme, the development of the Better Lives framework was a very definite positioning of a support offer that was really coming through the lens of the council and your whole life. The partnership between care and health and others is important in working through the self-evaluation within the framework, so that all people with a learning disability can live their lives in the community.
Sam Clark: Yes, I know. So, I think there is great opportunity in these two things. As you say, being used together to think about the vision, the aspiration of a Good Life and then the Better Lives framework being about what are our steps, our priorities, what do we need to work on here, thinking about people as a whole and a whole life. And from Learning Disability England's point of view, the opportunity to think about how that supports the inclusion of people in things like leisure, housing or employment and not just traditional specialist services.
Claire Bruin: From the council perspective, I guess the Better Lives framework does start with a focus on the care and support services that the council runs and arranges for adults with learning disabilities, however, when you're thinking about how someone can live their best life then you're going to have to think about all those other aspects of council business, like housing, leisure, culture and open spaces. You know those sorts of things all play in, so a council that is doing well in the way that supporting people will probably be better connected into those other elements. It might be more difficult if it's a District Council that's running some of those services, like housing, and you're in the County Council providing the learning disability services, but those relationships have to be developed for positive outcomes to happen.
Sam Clark: Interesting that you say that. One of the things that I'veexperienced personally in the past when I've worked in and with County Councils is sometimes it's the voluntary sector or the self-advocacy or the family group that can be the connector into the district area. So, I've experienced that sometimes, having that wider partnership supports the County Council's relationships into the specific district area, because they are the people of that town, and they live there. So actually, they can be much better connected, differently and at a much more granular level. So that's another reason why doing this work together can be really positive all-round.
Claire Bruin: Certainly, having had experience of working in a County Council and having a learning disability partnership board, District Council colleagues were key and particularly housing colleagues, and the board was a vehicle to bring people together.
For councils: to find out more about the Better Lives framework and how CHIP can support councils to self-evaluate against this framework contact [email protected], or for more on the Good Lives framework contact [email protected]