Can A Transformational Business Model Address The Care Sector Crisis?

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- 6 min read

The Local Cornerstone year two evaluation report was published last month. Cornerstone and other similar organisations can no longer ignore the ongoing pressures on the social care system.

Through our partnerships and influencing work we have joined up with like-minded people and organisations and Cornerstone is now part of an exciting social movement.

Local Cornerstone is attracting global interest, with organisations from New Zealand and Australia as well as other parts of the UK travelling to Scotland to see how it works.

Ambitious strategic plan

Our ambitious strategic plan was developed to address the challenges and opportunities presented by the changing social care sector, while ensuring that Cornerstone continues to provide a high standard of care.

Supported by funding from the National Lottery, Carnegie UK Trust and the Scottish Government, the Local Cornerstone approach has created a network of local branches and self-organising teams with autonomy to make decisions, allowing colleagues to spend more time with the people they support and less time on paperwork and processes.

The latest two-year report looks at the progress made so far, reflects on the challenges (and there has been many of those!) and lessons learned and sets out the priorities for the coming year.

The messy middle

I can confirm that during change journeys it is often true that everyone involved feels motivated at the start. We all look forward to the happy ending. But I can testify that it is in the middle where the hard work has to happen. In the middle we all have doubts – even the true believers like me!

I believe that stopping too soon or when unexpected obstacles and delays occur could be perceived, by definition as failure. Those who master change persist and persevere and those who recognise the struggle ‘in the middle’ will succeed.

Local Care and Support Teams

Local Cornerstone is built on self-organised teams of skilled social care practitioners, known as Local Care and Support Teams (LCASTs), and an ethos of empowerment and trust, supported by a flat structure of experienced coaches and mentors instead of a traditional management structure.

There are two quotes within the report that sum up for me all that we are hoping to achieve.  The first one is from the parent of a young woman supported by a LCAST in Aberdeenshire;

“Local Cornerstone now makes sense. I can see the benefits of not having one named person to answer to.  Working in a team brings out diverse ideas and opinions.  It’s how I want my daughter to be supported”.

The second is from the University of Strathclyde independent researcher;

“Overall the interviews with front line staff suggested a greater ownership of work, responsibility and confidence in decision making as a result of working in a LCAST which reportedly had led to a more person centred care being delivered”.

Results so far

Our initial target was to have 20% of the workforce fully up and running as LCASTs by March 2019 but this has been surpassed, with today over 80 teams (31%) at various stages in the journey.

A total of 11 LCASTs from different services across the organisation are currently being used as formal test sites for the next six months, which will lead to a wide roll-out of LCASTs if the results are positive.

Early indications suggest that when compared to a more traditional structure, recruitment and training costs are reduced, staff retention and engagement are better and there is also less reliance on the use of agency staff.

What does staff say?

According to most of our LCAST members, the changes have been for the better;

“Working for Cornerstone in the old days, we used to feel shackled. We often needed simple, common sense decision making but we didn’t have the authority or the information we needed to make those decisions”.

“In April 2018, we became a LCAST and everything changed. We could buy a new pair of boots or replace a ripped jacket for the individuals we support without having to ask anyone other than our own team. It’s so reassuring for us that a group…who really know the individual are the ones making the decisions which are in their best interests".

“Thanks to being part of a LCAST and the autonomy it has given me, Rudi came into our lives.  Rudi is in training to become a therapeut much to the delight of the people we support”.

“As a self-organising team we gained the autonomy to influence how transitions happened. We were included in meetings with social workers and this felt really important. We were able to advocate directly on behalf of the people we support. We think that, although there have been some issues, the way we handled the transition has been more in the residents’ interests than it might have been. They were given time and space to get to know each other and if things had been rushed it wouldn’t have worked so well. We know them best and we were the ones in those meetings who were able to say – it needs to be this way”.

Inspire to change

The LCAST approach allows colleagues to make quicker decisions about support for individuals, providing greater choice and a tailormade approach for each of the 3,000 people who are supported by the charity.

The model allows teams a high level of autonomy, enabling colleagues to make quick decisions about support for individuals, providing greater choice and a tailor-made approach that can really improve the quality of care and support they provide.

The introduction of Local Cornerstone has definitely  not been without its challenges, but we hope that by capturing our journey and sharing the lessons we have learned along the way, we will inspire others to change.

Next steps

The priorities for the next 12 months include tests with commissioners to move away from the arbitrary trading of an hour of care as a commodity and a financial evaluation to demonstrate the financial sustainability of the model. The results of both of these exercises we will use to influence change in the way social care is commissioned and funded.

The overarching objective of our efforts will always be to continue to put people at the centre of our activity and assist them to live the life they choose, using our charitable income to do some amazing things that help them to life a valued life.

Edel Harris (@CornerstoneScot), one of Scotland's largest charities, as Chief Executive in May 2008 having previously been Deputy Chief Executive of Aberdeen Foyer. Edel is also a Director of the Aberdeen Football Club Community Trust, Director of Scottish Council for Development and Industry (SCDI) and served as the first female President of Aberdeen and Grampian Chamber of Commerce.

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