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Local authorities need to encourage greater independence for vulnerable and elderly adults living in the care system, says Paul Martin who describes how his own council has transformed its service The Beveridge Report of 1942 signalled the end of the poor house, the start of the welfare state, and set out a vision of universal free health care and education. It promised a ‘helping hand' from the state to the citizen in times of personal distress, when traditional family systems did not exist or had failed. It certainly did not see the state as being the major provider of care for the elderly and vulnerable. Sixty-eight years later, it is right to acknowledge the achievements of the welfare state, and it is also our responsibility to question whether an unintended ‘dependency' culture has been created. This was not the vision of William Beveridge or subsequent governments, and yet we have arrived at 2010 where we find ourselves challenging care models which ‘infantalise' vulnerable adults, particularly in learning disabilities services, and a wider culture of a ‘risk averse' approach to commissioning care that supports independence. Welfare dependency not only erodes personal freedom and independence, it is also expensive to the whole community. I believe the time is now right to transform the way the public sector delivers services to vulnerable adults so that independence is promoted and the social contract between the individual, family and state is redefined as a ‘liberating' rather than ‘dependency' relationship. Sutton LBC is at the forefront of that transformation, with ground-breaking work under way in adult social services, radically improving the lives of some of our most vulnerable residents. Our approach frees up scarce council resources as we maximise access to universal services. When I arrived at Sutton in 2005, the situation was somewhat different. But we have created huge change in a short period of time. Sutton is realising that very fashionable ambition of doing more for less. The recruitment of a new director of adult social services and housing in June 2006, and the creation of a new joint executive head of service (learning disabilities) post between the council and NHS in May 2006, led to the delivery of stronger leadership in strategic commissioning and strengthening of professional governance. Both successful candidates were outsiders to Sutton and had a passion to deliver the best for citizens of the borough. This team reviewed the rising costs of social care and set out a vision of enablement and independence. With our local NHS partners, we saw the [local] Orchard Hill Hospital closure as an opportunity to deliver a major modernisation programme across the council and PCT which resulted in new care models delivering personalised services. There were significant savings delivered to the NHS through the NHS business case for Orchard Hill, and the council made significant efficiencies through its approach to personalisation in day services. Both approaches cost less then the institutional models they replaced but more importantly, outcomes for users have been astonishingly good. Better outcomes for the most vulnerable costing less than traditional institutional models. It's a sustainable model of care, because it is affordable. An example I would like to give is of Glynis who was admitted to Orchard Hill Hospital as a child and had been institutionalised all her life. She was assessed as having severe learning disabilities disorder, and possessed a vocabulary range of about 50 words. As late as 2006, doctors felt she needed a mental health hospital for the rest of her life, at a cost of between £3,000 and £4,000 a week. A social worker assessed her needs as being best met in supported living in the community, ie, her own home. Glynis moved to supported living in 2008, now has a vocabulary range of more than 1,000 words, shops at the local Sainsbury's and, as she proudly states, lives a better life. Her family celebrate what they describe as ‘finding their sister again'. Glynis is a much-loved neighbour who is now celebrated by, rather than hidden away from, society. A recent inspection by NHS London found that those who had moved out of Orchard Hill Hospital and the local NHS campus into their new homes were making ‘remarkable progress.' It said ‘the prevailing wisdom of moving people slowly and expecting slow changes over a long period of time has been turned on its head, with people having lived institutional lives now making rapid progress beyond expectations.' Our next step is to see how we can apply the same approach to all of Sutton's citizens in institutions. Paul Martin is chief executive of Sutton LBC

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Why independence is key

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