Supporting the adult social care front door: A community coordinated approach (practitioners' guide)

The front door to adult social care is often under pressure and unable to help all who present. Councils who take ownership of organising a comprehensive, complementary offer from the voluntary, community, faith and social enterprise sector benefit not only their residents but also the efficient and effective working of their front door.

This report proposes a simple straightforward system model which details the necessary steps to offering useful alternative provision.

The model identifies important layers of organisation and principles. These are not only around key values (strength-based, co-produced, empowering people) but also working approaches (shared data, building networks, developing over time) that need to be in place to create a good quality alternative offer to run alongside the traditional front door.

The work is based on previous successful existing alternative provision and working with councils to identify missing elements before they are able to offer such provision. The ‘Community coordinated approach to supporting the adult social care front door’ is a way of delivering accessible and sustainable support to the community and supporting people to live healthy and independent lives. It engages the VCFSE sector to deliver a wide range of support to all who need it, not just statutory care to those who meet eligibility criteria.

The model has four layers and nine guiding principles. It has been designed to be flexible in recognition of the different needs and capacities of different council areas.

The ‘Community coordinated approach to supporting the adult social care front door’ is not designed as a short-term test or pilot, but for a local area to apply as a long-term investment to building the right relationships and collaborative arrangements that are sustainable.

This document is a ‘how to’ guide for the development of a community coordinated Approach to supporting the adult social care front door. Rather than being prescriptive, this guide aims to empower practitioners to think about what might work best in their local context and to provide the tools to help them.

SPINDL CIC created this four-layer model for a community coordinated approach to support the adult social care front door. The model is designed to adapt to any context. We recognise every context is different. A critical piece of learning is not to ignore these differences, but to build from wherever local strength lies.

The community coordinated approach to supporting the adult social care front door creates a layered approach to support a good life well lived in a flourishing community. Residents are engaged, with support to be actively involved, as co producers. Service delivery is defined through ‘enabling help’ (inspired by McKeith, 2021), using the ‘liberated method’, (inspired by Smith, 2023), with networks of support and co governance and a set of principles to apply. 

The model relies on full collaboration with, and leadership from VCFSE and most importantly focuses on people, bringing them into the centre of a newly designed systemic, place-based ecosystem approach.

What is different about the community coordinated approach to supporting the adult social care front door?

A community coordinated approach to supporting the adult social care front door enables access to wider assets and supports within a place by creating a coordinated VCFSE access system that deals with multiple needs simultaneously, whilst maintaining established access routes. There are also dedicated resources to nurture resident engagement and involvement, stimulating resident-led action.

Key to success are systems to enable collaborative working across multiple VCFSE at operational and decision-making levels.

The insight gained from work so far leads us to propose three sets of considerations to continually hold as you progress the work in your area:

• Build action in each of the four layers
• Practise the nine principles
• Reflect on outcomes and continually adjust the model to better fit your needs.

Build action in each of the four layers:

• In line with the principles, the specific starting points will be defined by the strengths of your local system. We would suggest building from those strengths outwards – always keeping the whole model in mind.

Organisations need to reach into communities to build relationships, create connections and catalyse resident-led activity, recognising that this leads to focusing on their priorities, rather than those of the organisation. Part of this entails connecting and nurturing citizen-led action, as well as supporting people with needs, for this to be effective.

Think about asset-based community development (ABCD) and the community organising framework supported by community organisers. Nesta has useful information about ABCD. Key is valuing the contributions residents can make in this model.

This could be supported by a community anchor network like Kirklees and North Yorkshire or by community builders as in Torbay or a combination, as in Doing Good Leeds and ABCD Leeds.

For your council area, consider:

• who is doing this, or could do this in your area?
• what organisations are strongly rooted in their communities?
• how are they, or how could they be, nurtured and connected?
• how strong are your participation/ support groups and health-based patient activity in your area?
• what community activity do housing associations and other VCFSE deliver in your area?
• have you considered mapping your assets jointly?

A useful framework for this layer is ‘enabling help’ (inspired by Mackeith, 2021 and Smith’s Liberated Method, 2023), which is:

• relational – building trust to engage with help
• motivational – building belief that change is possible
• developmental – valuing and building capabilities to do things differently
• holistic – looking at the whole picture and joining the dots
• flexible – tailoring the help to the person
• contextual – highlighting the impact of the wider environment
• behavioural- tailored by behavioural insight models.

To maximise its impact, the framework should extend beyond adult social care to encompass all services, supports and activities. Central to this approach is organising around people rather than organisations. The person being helped is a co-collaborator, not a passive recipient.

Key considerations for implementing the technical aspects of a community coordinated approach to supporting the adult social care front door include:

• coordinating access to a variety of support and activities, aligning with Principle 7, through a customer relationship management system (CRM) to ensure both 'journey' for the person and the data necessary to manage a smooth flow through different parts of the system.
• ensuring equitable access for vulnerable groups, including those with protected characteristics, through local access points, face-to-face entry points, and a dedicated telephone line with sufficient capacity and effective referral systems.
• meeting the standards for ‘enabling help.’

For your council area, consider:

• do you have services in your area that can demonstrate they meet the standards of ‘enabling help’?
• are there examples of where managerial practices are supporting ‘enabling help’ to flourish?
• is there opportunity to build ‘enabling help’ into commissioning?
• what systems are already in place that could be built on?
• what support do you need to develop this?
• pay attention to enabling specialisms to be drawn upon, as required.

The concept of a network of support could be evolved in this context to create a better way of aligning support and collaborating. Networks come in all shapes and sizes. There may be established networks in VCFSE, as there are often lots of independent groups and organisations, often interest or locality based. The model does not prescribe what these networks need to look like, just that they are key to fostering collaboration. Collaboration is vital for the model to work, with the learning on how to ensure networks are effective outlined below.

Networks replicate the heart of community, just as the village green or town square facilitates connection and exchange. Organisations, such as Plymouth Octopus and Torbay Communities have worked to identify what networks need to thrive. These ways of organising are needed to bring the different stakeholders together in order to support a good life well lived. Stakeholders include residents, businesses, VCFSEs, primary care, councils, hospitals and wider integrated care systems.

For your council area, consider:

• How often does the council convene open meetings to hear from residents? These meetings are less structured than formal meetings, but help to build relationships.
• What networks or regular meetings of VCFSE organisations exist in your areas?
• How inclusive are these networks or meetings of the smallest community organisations?
• Are networks adequately resourced to be effective?

Resources:

• Plymouth Octopus Learning on effective networks
• Why and when are networks useful?

This layer, co-governance, is the least well-developed area of practice perhaps because it requires some of the largest and most radical shifts. For example, it might require different:

• contracts: it requires contracts that can sit between multiple parties, not just a simple bi-lateral agreements
• decision making: it requires radically participative decision making
• funding flow: it requires methods of financial management that can follow emergent processes and decision making based on relational ways of working.

Each layer is intimately connected to the other layers. The ideas and ways of understanding the world (our paradigm), inform commissioning, which then impact on how services are managed. How services are managed impacts on how services are delivered. Pressure to hit targets coming from management can impact services, causing practitioners to focus on targets rather than people's needs.

Moving to an enabling approach is a paradigm shift in the fullest sense, implying change at all levels of the system.

The National Lottery Community Fund has suggested that building common purpose (co-missioning) using grants, rather than going through a commissioning process may be a better way of resourcing ongoing community-led work. This aligns to concepts such as Alliance Commissioning bringing providers, commissioners and those offered services together in a relationship of equals.

How the system learns together is a significant indicator of how stable and robust the actions will be.

For your council area, consider:

• Are there any risk-sharing contracts in place with provider organisations?
• What focus has there been on building a culture of learning?
• How much autonomy do frontline staff have?
• What conscious efforts have been made to build a deep understanding of collaboration?
• Are we focused on joining the dots and creating a more systemic approach?
• How are we aligning practice, management, resourcing and governance to create coherence?

We’ll explore how these principles look in reality, building on other well-established models of good practice.

This model appears to have wide application in supporting councils to re-orient approaches to social care that better maximise the assets and strengths from across their system and from their communities.

There is value in building social capital and a sense of community not just for community health but also to promote and maintain the health and independence of individuals. Councils and their partners play a key role in supporting this development. This approach allows the promotion of independence and wellbeing of individuals, whilst conserving limited resources for appropriate and targeted use.

As part of its ongoing evolution and evaluation we would be grateful for any feedback which should be sent to [email protected] as part of our ongoing development programme.