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Think global, act… personal: sustainable development and the future of social care

Catherine Max describes innovative work by the Social Care Institute for Excellence (SCIE) and Bristol City Council to embed sustainability in the commissioning of social care.

Research commissioned by the Social Care Institute for Excellence (SCIE) identified Bristol City Council as a leading example of a holistic approach to sustainable development. The council has set ambitious targets for improving performance on environmental sustainability and introduced a number of corporate measures including environmental assessments of new proposals and strategies, and regular audits of services.

As up to 60% of the council’s total expenditure is on residential homes, environmental initiatives have been focussed on the Health and Social Care (HSC) directorate. Between 2005 and 2009, energy saving measures reduced HSC expenditure by 20%, an annual saving of approximately £100,000.

The council is now looking to embed sustainability into its commissioning practices. To help progress this, SCIE and the council have explored what sustainability means to local citizens and how this could shape the future of social care. In particular, we wanted to deepen our understanding of the implications of personalisation for the council’s sustainability objectives and explore whether personalisation could stimulate the market for environmentally sustainable services.

Personalisation: opportunity and risk?

‘If several people receiving community meals in the same street choose different providers this could lead to increased environmental impact and transport costs. However, community-based models of personalisation … have great potential to facilitate the development of care and support that is environmentally, economically and socially sustainable.’
Evans, Hills and Grimshaw, Sustainable systems of social care (SCIE 2010)

Personalisation in social care has the potential to transform the ways in which care is planned and delivered. As people become the commissioners of their own care, and increasingly the direct purchasers of services, block contracts and industrial-scale delivery will become things of the past. This presents both opportunities and risks for environmental sustainability.

The SCIE project was launched with an event designed to establish levels of understanding about sustainability among council, health and community stakeholders and to test the appetite for further engagement. Two neighbourhoods were then selected for focus groups to be held in community settings: Lawrence Hill/Easton and Bedminster. These probed issues of local importance spanning housing, transport and the public realm as well as care itself. The rationale was that this would help develop a more holistic understanding of needs across the life-course as opposed to a response to ill health or a care need at a particular time.

Quality of life and quality of care

‘We need ways to humanise the community.’
Focus group participant – Bedminster

Our most striking finding was that participants were either familiar with or well able to grasp the concept of sustainable development, but struggled with personalisation. Service users and carers may have concerns about service closures or may not realise that they can receive different kinds of support. The focus groups showed how exploring people’s experiences of where they live, the places and activities they enjoy, how they get around, what they like and what they would like to see changed, can open up more creative discussions about the future of care. Moreover, the ideas generated through these discussions were often simple and low-cost, as well as likely to promote independent living and care which is community-based.

Connectivity

‘Local [service provision] is important as it’s a tie to the community.’
Focus group participant – Easton

There was a clear commitment among participants to ensuring and enjoying a good quality environment suitable for all ages and circumstances, that is the community as a whole. The strongest themes to emerge were: quality of life, attractiveness and accessibility of the built and natural environment, and ‘connectivity’ between both people and places. Connectivity therefore encompassed social networks and ease of getting around, including accessibility and price of transport, the condition of pavements and parks, and personal safety. Getting these things right is of fundamental importance to people and failure to do so exacerbates – or causes – care needs. The view was repeatedly expressed that people who use services do not want to be ‘lumped together’ with other people who happen to have a similar care need, but instead want to be part of networks which are diverse and intergenerational. They also favoured provision that was locally based and staffed by people familiar with the local area.

Community assets

The final stage of our project was a further workshop to which previous participants and a wider range of stakeholders were invited. We shared insights from the focus groups and combined this with activities devised to generate specific, achievable ideas and commitments. Actions arising include plans to co-produce a community asset map showcasing different groups’ perspectives and experience on what Bristol has to offer, as well as partnering with the universities and volunteer groups to promote intergenerational skills-sharing. These are being taken forward in the context of the HSC Transformation Strategy, underpinned by ‘social return on investment’ principles.

Shaping future delivery: from global to local to personal

This was a relatively modest project involving self-selected participants. Nevertheless, the energy, insight and commitment of those involved regarding better care for themselves, their neighbours and future generations were palpable. Framing the discussions in terms of social, economic and environmental sustainability unlocked creative thinking and bridged personal and community needs in ways that traditional consultation about service provision struggles to achieve. There are lessons here for both commissioners and providers about the latent demand for services which are genuinely sustainable, and the willingness of citizens to think and act global, local and personal.

Further reading

For further information on the SCIE’s sustainable social care programme, publications and resources, visit the sustainability pages on SCIE’s website or contact Catherine Max at Catherine@catherinemax.co.uk

Catherine Max is a strategic consultant and independent advisor specialising in sustainable development, health and social care.
www.catherinemax.co.uk


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