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Local Area Coordination and Prevention

Author: Nick Sinclair

Local Area Coordination is an important innovation in health and social care, first developed in Western Australia, it is now being implemented in several countries. Nick Sinclair is the Director of the Local Area Coordination Network in England and Wales and describes here the innovation and its impact.

Nick spoke at the It's Our Community event organised by the Centre, in partnership with the Socialist Health Association and Opus Independents. The event is part of the Centre's work to outline a detailed progressive vision for social care in Sheffield alongside disability leaders in the city. This work may also inform wider work on social care reform. 

This article is about Local Area Coordination and how it can build a truly preventative infrastructure in our communities. There are certainly other dimensions to the approach, for instance the impact it has in helping people already accessing funded services to live their good lives, but in this blog I focus on its preventative aspect.

Local Area Coordination is an approach that emerged in Western Australia in the late 1980s and has been here for around 10 years. It has 30 years of evidence behind it (see www.lacnetwork.org). It is currently being led by 10 councils and is in 100 or so communities in England and Wales.

Whilst it is an asset-based approach, we’re often asked what’s the problem that Local Area Coordination seeks to solve? 

I think there are probably three interconnected issues that the councils doing this are trying to work on strategically:

Firstly, many people in society are still not able to achieve their vision of a good life. This as we know is often due to exclusion in some form for instance, exclusion from family, community, information and but when thinking about prevention, exclusion from services “eligibility” or funding.

Secondly, communities often evolve and develop without the involvement and contribution of those people facing exclusion – because of the fact they are excluded. This increases a likelihood for personal crisis as people remain disconnected and isolated, unable to share their gifts and make their contribution. 

Thirdly, our services are largely designed and commissioned to be reactive to crisis through individual, specialist responses. They are not necessarily designed to think about the ‘whole person’ and to work in a preventative way that builds capacity at individual, family and community level.

When we dig a bit deeper in to all of this, we often find these days that are few sustainable structures in communities that help people to be citizens, to think, to decide and act together with clarity of voice. This lack of voice means our policy makers and system leaders are increasingly reliant on headline data and overview insights when planning and making decisions that affect the lives of citizens and communities. This often leads to a bias for shorter term service “fixes” that fit the prevailing demand reduction narrative rather than ones that are long term, relational preventative and driven by values, principles and are co-produced with citizens and communities.

So, the question those adopting Local Area Coordination are often grappling with is “do we tinker with this or do we try and reform it by trying something fundamentally different?”

Increasingly we are working in areas where the approach has been recognised as something can help bring about genuine reforms to the way social care evolves locally. 

So how does it work?

We, the Local Area Coordination Network (part of Community Catalysts CIC), work with councils and local communities to co-design a version of Local Area Coordination based on core design features and principles. Local community members are involved in recruiting one coordinator for a population of around 8-10,000. Local Area Coordinators, who are employed by the council but based in communities are then present and accessible to take introductions to anyone who may need help to live their good life or might need input in the future if something doesn’t change somehow – introductions to Local Area Coordinators can come from anywhere – self introductions, local people, community groups, services etc.

They use a very particular approach where they take the time to listen, build meaningful and equal relationships, finding out the big picture of someone’s vision for a good life is. There is no limit on this time and no eligibility criteria for accessing support.

They develop shared agreements with the people they are alongside as to who is going to do what. This ensures the accountability of the approach.

There is often a significant focus on what local support and connections can be made to help people get to where they want to be with services and funded supports as a back up if really needed.
The learning from all of this is channelled to system leaders who then can make positive reforms based on real-time insights and not just overview data.

What impact does this have?

People and their families - multiple outcomes – people have a local, practical, accessible support available to help achieve good lives. They don’t have to be sign posted out of their communities for support (they are unlikely to be eligible for) and it stops people cycling around the system of support unnecessarily as the support is truly person centred and holistic. Crisis is prevented. 

Communities have a locally based, skilled Local Area Coordinator who is present to connect with and to introduce their friends and neighbours as concerns, queries or ideas for change begin arise. Bridges and trust are re-built between places and the wider institutional structures. Communities benefit from the input, gifts and contributions of those who are no longer excluded from community life due to their personal and family circumstances improving.

Service professionals have a named local person physically present in community to make introductions with regardless of service eligibility. The capacity it builds and crisis it prevents leads to cost avoidance, reduction and savings. It provides insights for commissioning, promotes culture change across health and social care, enhances co-production power sharing and a platform for better collaboration across the wider system. 

I just want to conclude with a short story that I think highlights the preventive aspect of this really well.

Ella was attending college, but her employment advisor was concerned that she had no income so together they reached out to Tammy, Ella’s Local Area Coordinator to see if she could advise on how Ella could get free food.
Ella and Tammy met soon after where she opened up to Tammy. She had been denied the benefit she needed 8 months before. She had no income and no family and no network of friends supporting her. She was facing eviction, had no access to food other than soup kitchens in the city centre and struggled to get to those due to the cost of transport

Her physical and mental health were deteriorating and she told Tammy she felt very isolated. When they looked in to the support she was getting, she was receiving intermittent support through her social housing landlord, an employment and advice service and a homeless charity. 

Tammy was able to help Ella join these services together to get the full picture of this offer. This included initially offering quite a lot of practical support, for example agreeing to pick up food parcels for Ella, attending meetings with her landlord and the welfare rights team. 

Ella managed to secure her tenancy until a pending tribunal where she won her appeal and all her benefits were back dated. Ella paid off all of her arrears and was then able to focus on her health. Throughout the time they’d been getting to know each other Tammy had also introduced Ella to various community people and places in her local area. In doing so she has since met people in her community who now are now offering her natural emotional support through friendship.

Ella now gives back to others with her time and gifts through volunteering whilst she continues with college and searching for work. She told Tammy she now feels more in control, safe and secure in her tenancy and is exploring future housing options with optimism. She is able to concentrate on recovering both her health and mental health and has the income to do so. Ella isn’t closed to Tammy (as that’s not how it works) and she continues to be a presence, walking alongside Ella as and when needed – Ella knows where to find Tammy if needed, but she now has natural support from her community.

So that story of prevention really highlights the logic of the approach:

  • Being local rooted in community but still well connected with services
  • Practical input that is centred on the whole picture and the whole person
  • Not being limited by eligibility or time
  • Knowing where the hyperlocal potential natural supports exist in community and making those connections
  • Seeing the big picture and not just focussing on one part of it
  • Being present and accessible if needed in the future without closing people down

Part of the preventative value in Local Area Coordination is due to the fact that it isn’t solely a community led thing and therefore limited to the extent of neighbourly support and community infrastructure and it isn’t solely service led thing either, limited by eligibly criteria and thresholds, but something that that inhabits a grey space between the two. When designed right this can make a huge difference in building the capacity of both worlds, helping to create a truly preventative community infrastructure.

Visit the Local Area Coordination Network website at:

https://lacnetwork.org


The publisher is the Centre for Welfare Reform.

Local Area Coordination and Prevention © Nick Sinclair 2021.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.

Contact

Ralph Broad

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