Dame Philippa Scoc Conference Cardiff October 2011

8/3/2019 Dame Philippa Scoc Conference Cardiff October 2011

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THINK LOCAL, ACT PERSONAL MAKING IT REAL IN COLDCLIMATE.

PHILIPPA RUSSELL,CHAIR,STANDING COMMISSION ON CARERS,E-MAIL: [email protected]

Philippa Russell

Chair, Standing Commission on Carers,

E-mail: [email protected]


2/21

Think Local Act Personal..

A new sector-wide Concordat for

users, carers, councils,

commissioners and providers.

Making progress towards

Personalised, community based

support.

Transformation in a cold climate!

Hard but also an opportunity.


3/21

Caring for our future - The six questions

Quality: How can we improve the quality of care and support achanging workforce?

Personalisation: System change to self directed support!

Shaping local care services: How can we ensure a wider rangeof innovative and responsive care and support services thatrespond to individual need and focus on outcomes not crisismanagement?

Prevention: How can we support more effective prevention andearly intervention to maximise and sustain maximum independenceand good health for users and carers?


4/21

Caring for our future cont..

Integration: Good outcomes for social care and support will inmany cases require changing practices within NHS. How can webetter join up social care, health, housing, education and trainingetc and join up Personal Health and Social Care Budgets?

The role of financial services: Innovation requires investment!What is the role of financial services in shaping changing services?

A reflection on the six questionswhat will be the role of the

new micro commissioners and providers, the users and familiesthemselves? Are families and users themselves also among thenew venture capitalists in doing things differently, eg personal

finances, pooled budgets?


5/21

2lst Century carers, a reminder on who cares

Around 6 million carers, 4.3million of working age. 54% ofcarers give up work to carecarers emphasise that best supportwould be quality care for their relative. Improvements in medicalcare mean new survivors with very complex disabilities but

implications of shift from NHS in-patient to domiciliary care.

1.25 million carers now provide care for more than 50 hours aweek. Value of carers contribution estimated at 118b (cost of

NHS is 98b pa). 70% of long-term carers report that caring has a

negative impact on their own physical and mental health.

New sandwich generation of multiple or mutual carers (60% ofchildcare now provided by grandparents, some families caring forthree generations).


6/21

PersonalisationTreating people equallydoes not mean treating them the same!

The rise of the Personal Budget! NationalPersonal Budget Survey (2011) showed majority of 2,000respondents reporting better outcomes.

Key factors in satisfaction included: A navigator for the system: Good information and advice in

planning personal care (for carers and those they support).

Real options, a focus on outcomes about how Personal Budget ismanaged.

A market place with something to sell: carers supported to findright mix of care and support.

Think family: Care and support may affect multiple family members(eg distance caring; intergenerational caring; young carers etc).


7/21

Personalisation Some challenges as well asopportunities

Challenges: Anxiety about options for organisation and money management.

Developing a market place for wider range of services.

Concerns about possible loss of existing services without

adequate replacement. Challenge of interface with health and other services.

Opportunities: Flexibility (eg Shared Lives).

Innovation (eg use of assistive technology)

User friendly (eg support for user to use mainstream servicesrather than social care provision).

Self Directed Support (eg carers feel in control and can tailor

care and support to meet their desired outcomes).


8/21

Personalisation means acknowledging cultural, social and age-related preferences in lifestyle and support. Particular anxietyabout ageism and negative stereotypes around older people.


9/21

What is care and support for?

Getting a life (eg support to work, enjoy family andcommunity life, gain greater independence)

Recovery/reablement (eg after a stroke,accident)

Maintenance (eg older people wishing to remain inhome and community)

Managing change and transitions (eg into own home)

Crisis management (eg abuse,

loss of family carers) Whole family support (when

multiple family issues or needs)


10/21

Think Family!

People with higher support needs can be heavily relianton families and carers who often have the power andinfluence to kill or drive an entrepeneurial idea[Community Catalysts, 2011]

Families are the new micro commissioners and the newmicro providers. But they need high quality information,advice and support to do things differently. Its easy to

forget the emotional side of caring, the what ifs. Id liketo see us use the New Zealand system of Whanau,

whole family discussions and engagement in the future.

[Family Carer, 2011, at meeting on personal budgets]


11/21

Thinking positively valuing families, valuingdiversity

Personalisation means re-focusing on

users and carers, their lives at home and

in the community and being ambitious.

No assumptions about role or aspiration

of user or carer: building employment options

and other family responsibilities into assessment and

resource allocation systems.

Personal Budgets a balance of interests? Managing bothcarers and users aspirations and preferences.


12/21

Co-production - the cornerstone ofpersonalisation.

Seeing users and carers as expert partners.

Recognising the emotional as well as practical

challenges of doing things differently.

Attitude change

Creativity and innovation and

use of new technology (eg telecare)


13/21

2lst Century care and support new options aroundemployment

I became a carer overnight when my husband had a stroke. Hedid make quite a good recovery. But the discharge fromhospital was a nightmare. I had to give up work after sixmonths and we could have lost the house. We were so lucky,with a sympathetic GP, a good CIL and a wonderful PA for my

husband, we got our lives back. The Personal Budget made uscitizens again!

Personal budgets? I didnt want a

day service, I wanted a life. MyPA has madeit happen.


14/21

Work matters! [Professor John Glasby, 2010,The Case for Social Care Reform]

[We need] an approach which seeks to gain broader social

and economic benefits from investment in social care. Areresources currently over-focussed on crisis prevention in acutehealth and social services with insufficient investment in preventionand wider community services?

The evidence [on outcomes from investment in social care]

suggests that many carers are disadvantaged and prevented fromcontributing more fully to the economy and society through

spending so much time caring and with lack of support. Greatersupport for carers could lead to additional earnings of 750million for working carers, hence social care should be seen asa form of social and economic investment rather than crisismanagement for both individuals and society as a whole.


15/21

Carers Strategy Refresh - measures proposedto help carers balance caring with paid work.

Extending right to request flexible working.

Designing in flexible working arrangements in job

design and recruitment.

Developing an all-age career service. Continue investment in support for carers returning to

work through Jobcentre Plus.

Promoting growth of assistive technology in supporting

carer employment and user safety and well-being. Ensuring carers have informed and responsive line

managers.


16/21

Employment opportunities for people of working agein new systems of care and support!

Some key messages from the Sayce Review (2011) on newdirections in employment to support disabled people into work

can we apply same messages to carers?

Rapid information, support and adjustments to aid job

retentionand/or advice on social enterprise options. Flexible and ongoing support for employees and employers

where needed to get in, stay in and get on.

Working with employers, recognising that small and medium-sized employers less likely to have resources to do things

differently. Working with Jobcentre Plus advisers to support and where

necessary constructively challenge employers .

Positive images of carers as valued members of workforce!


17/21

Getting a life what do carers and users reallywant?

Treating people equally does not mean treatingthem the same: Recognition of the family, cultural, social andage related context for decisions about care and support.

Managing transitions:From school to adult services, fromhospital to home.

Recognising the range of family priorities: Families

may have multiple care needs (eg children, older relatives)support may need to be tailored to working lives.

Managing anxieties: Closure of traditional services seen asdisaster unless clarity about alternatives.


18/21

Doing thing differently the rise of thesocial enterprise!

The communication challenge: Users, carers, Councils,commissioners and providers need new understanding of what wemean by care and support.

Finding the local leaders and entrepeneurs(and takingthe risk out of doing things differently.)

Market intelligence - Knowing your community: Fromdog walking and duvet washing to horticulture and herbs, makingthe business case.

Market DevelopmentA new dialogue between providers,

commissioners and users/carers .


19/21

What if? Safeguarding and risk

management

Challenge for CQC and other regulatory bodies and for userand provider networks: current focus on residential care(Winterbourne View, elder care in NHS provision) BUT:

Proportionate risk management a challenge for all services:Adult Safeguarding Boards statutary requirement - can we usethem creatively and strategicallyto improve confidence in qualityand safety of local services?

The duty to investigate people using services who may be atrisk of abuse of harm: Steven Hoskin case (and EHRC report,2011) a reminder that the community can also be a dangerous case

How do we balance personal autonomy with personal safety?


20/21

The Public Sector Equality Duty

Equality Impact Assessments and JSNA offer opportunities forproviders to work across traditional boundaries with local carers andusersas strategic partners in developing and shaping local careservices.

Providers as users and carers champions

Public Sector Equality Duty: Are local

Commission arrangements proactive in:

Eliminating unlawful discrimination

Advancing equality of opportunity

Fostering good relations


21/21

We can do things differently.

Personalisation: A concerted focus on REAL choice andeffective use of resources.

Shared lives: We ALL share lives in different ways but wenow have the opportunity to think differently about choicesand longer term outcomes.

Social enterprise: Lets model our expectations of disabledand older people on other citizens in local communities.butremember that changing services means mutual respect andunderstanding on a very different journey.

Documents

Dame Philippa Scoc Conference Cardiff October 2011