- Hospitals and healthcare
- Long-term conditions
- End of life care
- Learning disabilities and autism
- Mental health
I am expected to make cuts – can I do this and still support people well?
It is awful to be in a situation where you are required to make cuts or savings.
Most of the time, this is not done in a way that involves the person at all, but there is an approach that focuses on making sure people have ‘Just Enough Support’ that can be used to make sure that existing funding goes as far as possible.
It is also a way to cost a service, or to see how savings could be made in the least detrimental way possible. This is not in any way to condone the way that cuts are being made. ‘Just Enough Support’ refers to the optimum level of support that will increase the chances of people connecting with local people in their communities (we developed the process together with Imagine And Succeed (I.A.S), building on the work described in the paper, ‘All Together Now’.
If we use resources effectively and actively reduce reliance on paid support, while working in ways that enhance relationships and involve people in their community, then we can achieve a better situation for:
- the person – who will have a wider variety of connections and relationships
- the organisation – which will be able to target scarce resources most effectively, and
- the community – which will benefit from the contributions and presence of disabled people.
There are four stages to providing just enough support: generating ideas, testing them (do they work for the person, and do they provide enough support?), trying them in practice and reviewing them.
To generate ideas, we first of all clearly identify what support is needed and when it is needed. Then we think about three possible ways of providing it – starting with people in the person’s network and in the community, then assistive technology and finally paid staff.
The process involves a group who can generate ideas, and to check and test these out with the person if they do not want to be part of this group. The group thinks together about how to deliver the support that a person needs to have their ‘perfect week’. Here are the 4 questions that the group look at:
1) Exactly what support does the person need?
The group accurately describe exactly what support the person needs, how much and how often – not how we currently provide it.
2) Are there other people or community initiatives that could help?
You would use the person’s relationship map and community map (both person-centred thinking tools) to look at whether family or friends could help. Then look at community initiatives like Timebanks.
3) Could assistive technology help?
4) Are there ways we could think differently about paid support?
These ideas are tested with the individual (do they reflect what is important to you, and do they deliver just enough support?), and then put into practice. Where paid staff are needed, they are matched to the individual, and this information is put into a personalised rota. Everything is reviewed through a person-centred review. Here is a story about Anne-Marie and Just Enough Support, and a webinar where Ruth Gorman describes the process in more detail.