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A Social Enterprise providing community based support for adults with learning disabilities and/or autism and mental health in the South West


27 June 2022

Like most social care providers, You First receives almost daily calls from Commissioners of support, asking if we have capacity to respond to emergency situations where support for someone has broken down in some way. When we ask the question “when would you like this support to start?” the response is usually “right now, can you start support tomorrow?”

Whilst You First is fully staffed (we are not currently carrying any Support Worker vacancies) we do not have surplus team members, and therefore cannot immediately respond to such requests. No provider can carry surfeit capacity, we are simply not funded that way. You First operates in the way we do because we deliver person-centred, self-directed support.

We need our model of commissioning to change, such change is required to ensure the nature of support changes. Traditional models of commissioning create a task-centred response which in turn deliver task-centred support. This will mean providers will throw staff at the "service" as opposed to matching people with the person supported with the inevitable outcome of support breakdown in the future. The person supported will become labelled as "challenging," "complex," "difficult" and so on and this will result in team members, through no fault of their own, interacting with labels and not the person, meaning trusting and respectful relationships will not be established; and relationship is the bedrock of social care.

We have developed our own toolkit for supporting people, based on NHS England's Individual Service Design model. However, we know people don't want a service, they want a life, hence the name we have given this toolkit.

Design4Life! brings full attention to the person themselves, not in terms of a list of needs or assessment of deficit, but rather in terms of who the person is as a human being. The process is time intensive, going all the way back to the start of the person's life and detailing life events, milestones, development and responses to life experiences and as a result it paints an in-depth picture of who the person is, what matters to them in life, their worldview, how life has shaped their expectations of themselves and others and it also captures their hopes, dreams and aspirations. Everyone close to the individual is involved in this process and capturing of the person's life story in this way is absolutely vital and it is one that is consistently ignored in the traditional assessment process. None of us have suddenly appeared on this planet as adults, we all have a history, and we are the product of that history, psychologically, emotionally, spiritually, and so on. People supported are as three dimensional as you and I and to ignore this is to deny the person the ability to build and grow their lives. Design4Life! captures the nuance of life, and it is this that often informs how we intra-act and interact.

Matching is a key part of the Design4Life! process. The process allows the person supported and those close to them to describe what a good Support Worker would look like to them and a bespoke recruitment process follows, involving the person supported as much as possible, and their family members where appropriate, and the result of this is a Micro Team that is dedicated and bespoke to the person supported. Micro-Teams are essential to the delivery of complex support. Relationships will not be established if people are supported by a never ending flow of strangers. Micro-Teams are unique and dedicated to the person supported, small enough to ensure the development of relationships with mutual respect and trust at their core, and large enough to ensue cover for leave and on-going training. Person-specific training forms a major part of Micro-Team development and again, people supported and those close to them have direct involvement in helping us develop this training and in some cases deliver aspects of it themselves.

The Design4Life! process includes housing. With our housing provider we can source bespoke housing as we understand that the immediate environment supports a person as much as any individual. "Home" is part of the support package, and again is one that is continually overlooked. Traditionally, people are found a house, or a room in a house, with people being slotted in as and when a vacancy or “void” presents, and this house is supposed to be home, when in truth the environment should be built around the individual as much as the team. Many people, most especially autistic people, struggle with sensory processing and the home should be designed in such a way that it manages the individuals’ sensory diet and as such becomes a place of genuine refuge, comfort and support.

For many years the cry in social care has been that “one size does not fit all”. We cannot squeeze people into services, yet because commissioning often operates from crisis, this is all too often the case, with support breakdown being the inevitable outcome. In a bid to resolve short-term crisis the longer-term outcomes are not considered. People cannot build and grow their lives if they live in a state of constant flux with their home and support constantly changing. People will naturally become cynical of the commissioning process and of providers of social care if they consistently provided with short-term fixes.
Our approach to both commissioning and support must change if we are to deliver consistent support that empowers people to exercise genuine choice and control over their lives and this means a genuine embracing of self-directed support where people are in charge of their personal budget, who supports them, how and when they are supported and what that support looks like.

Design4Life! Is You First’s contribution to help make this dream a living reality and people building and growing their lives is the outcome. For example:

  • Someone who was previously supported 3:1 is now supported 1:1 and also enjoys an hour a day when she has no support.
  • Another person has been supported to pass his driving test and get a job. He now has a girlfriend and no longer requires support.
  • A young man with complex epilepsy is supported to take risks and enjoy an active and full life and his family take a lead role in training team members.
  • A young lady has built her own team around her, designed her own roster, and enjoys flexible and responsive support that she is control of.
  • A man whose needs have dramatically changed, causing him confusion, frustration, and distress, has established a close Micro-Team around him who know him well, and whom he trusts, thus supporting him through a distressing time compassionately and respectfully.
  • Two people who were living in short-term rented accommodation have been found forever homes through our relationship with our housing partners.

Design4Life! sees people move out of Serviceland and enables choice, control, self-determination, and the genuine empowerment needed to make these things a reality.

If you would like us to deliver a presentation on Design4Life! to your team, please do not hesitate to contact us as we would be very pleased to do so.