Insert Local Authority

Transformation Strategy Workshop

Insert date

This document is part of the personalisation toolkit

www.dhcarenetworks.org.uk/personalisation

Introductions

• Your name and role

• Your current level of knowledge of the transformation agenda and self directed support

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

Objectives

• Gain a shared understanding of the transformation agenda

• Agree what transformation means for INSERT LOCAL AUTHORITY

• Plan what work needs to be done when

• Agree how to approach a pilot

Transformation agenda- What’s it all about? Universal services – Adult social care must provide support for

all adults with social care needs and their carers, including signposting and help in accessing a range of services that are available to all including services outside of adult social care such as transport, leisure, health and education.

Social capital – developing the community and encouraging individuals to make use of all resources available to them in the community, including personal networks (family and friends), community groups, the voluntary sector and other informal support

Prevention and early intervention Helping people maintain good health and independence with

low level support. Identifying people at risk of losing independence and giving

them support early. Helping people get back on their feet after illness, for

example through “enablement”. Choice and control – ensuring people have greater choice and

control over their lives, including through self-directed support.

Citi

zen

ship

Info

rma

tion

Life

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e

Pra

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al s

up

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rt

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rly in

terv

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tion

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Cris

is /

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esp

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se

Inst

itutio

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l avo

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nce

Tim

ely

dis

cha

rge

General population

Complex needs

Substantial needs

Low to moderate

needs

Prevention and Intervention have avital role

There are activities at every stage which can improve quality of life and reduce demand

Benefits of transformation

• Benefits for users– Increased choice and control– A shift in power from the council to the individual– Greater flexibility– Prevention and early intervention improves quality of life

• Benefits for councils:– Increased transparency of resources and budgets– Greater flexibility and equity in provision across all adult groups– Greater awareness of support networks that exist in the community– More efficient process

‘Putting People First isn’t just a vision for social care. It demands that all parts of local government ask some fundamental questions about the types of communities they want to build’

Phil Hope, Minister for Care Services, 2009

Co-production

• Co-production is a key part of this agenda• Real change can only happen by engaging users and carers

throughout • Personalisation means empowering people to develop solutions

that work for them

Putting People First… “seeks to be the first public service reform programme which is co-produced, co-developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services and to win the hearts and minds of all stakeholders’, especially front line staff”

No longer IF but HOW

‘Transforming social care’ makes it clear that all local authorities have to change their social care model and that this will involve a significant amount of work.

“We have a long way to go to give everyone more choice and control over the care and support they receive. Local councils are clearly working hard to transform their systems to do this. We need to work together with local communities to ensure this progress continues.”

Phil Hope, Minister for Care Services, May 2009

No longer WHEN but NOW

Councils and partners are working to deliver significant progress by 2011.

“The information given to us from councils indicates very strong progress amongst a number of councils. We are confident that this will become widespread over the coming year”

Jeff Jerome, National Director for social care transformation, May 2009

IBSEN report

The IBSEN review of the individual budgets pilots was published in November 2008, with a carers evaluation published later.

The key findings included:- More people felt in control of their lives- More people taking up direct payments- Many people continued to use mainstream services- Need for better access to support planning and brokerage- Mixed evidence about the early outcomes for some people- Some challenges about making it work for some groups (such as older people) - Mostly positive results for family carers

Transformation framework: summary

Phase 1 Full PotentialSwitch On

Investigation

Blueprint(Develop)

ImplementationPlanning

Implementation

InvestigationBlueprint(Enhance)

ImplementationPlanning

Implementation

Blueprint(Review)

ImplementationPlanning

Implementation

Limited Launch Expanding the new approach to all

Optimising the systems

Monitor & Sustain

Personalisation – what the words mean

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

What counts as a success?

• Success is about service wide transformation - offering a personal budget or increasing direct payments is not enough, but is a key step

• The principle is to offer maximum control and choice while effectively managing risk

• The development of universal services and social capital have an important role to play

• Co-production is a key tool in transformation

• Reducing demand on services through a combination of prevention and early intervention.

Defining success for INSERT LOCALAUTHORITY

1) What elements constitute successful implementation of transformation?

2) Which of these can we measure?

3) Can we define success in one sentence?

4) When can we describe transformation as “mainstreamed”?

You need to define what success means in your area

Efficiency?

Genuine choice

and control?

Greater control

over limited

finances?

Less reliance on local authorit

y?

Improve-ment in outcom

es?

Avoiding bad

press?

Evidence of new options in the

market?

Everyone acting as

self-funders?

Inclusion

of more funding streams

?

Maintain/

improve CQC

rating?

Demon-strable culture change?

Various perceptions of success

A new ‘agreement’ with citizens?

Increased

SocialCapital?

More Co-producti

on?

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

initial contact assessment -

advice and signposting

Meet immediate needs and

enableAssess

The Customer Journey

Calculateinitial personal

budgetSupport plan

Authorise&

validate

Universal services and

early intervention

Go liveMonitor &

review

Self-directed supportEarly intervention

How can you help customers stay independent?

First contact - advice and signposting

Meet immediate needs and

enableAssess

Calculateinitial personal

budgetSupport plan

Authorise&

validate

Universal services and

early intervention

Go liveMonitor &

review

Review may suggest enablement

Those not eligible for a package can get further

information

enablement prevents requirement for ongoing support

Continually look for opportunities to enable, signpost or give advice

to increase independence

Encourage to the left, not inevitable drift to the right

Elements of transformation

• On what is there already a INSERT LOCAL AUTHORITY consensus?

• At what stage should other decisions be made in?

BlueprintImplementation planning

Implementation

Breakdown of activities for target operating model

• The following slides demonstrate how the transformation framework can be applied to the self-directed support element of the customer journey

• The principles and questions which are raised for each stage (e.g. blueprint, implementation) can be applied across the transformation agenda.

Breakdown of activities for TOMInitial contact assessmentProvision of information for individuals using or interested in social care services (including self-funders) is essential to allow genuinechoice and control. This covers information available via all channels(web, phone, face-to-face etc) at first enquiry stage and throughout the

process.

• Develop new information resources – print & online• Decide role of Council’s contact centre (e.g. will the council do initial

telephone assessments?)• Explore options for on-line contact• Review appointment system with professional staff• Develop information for self-funders • Training and development for ASC & customer contact staff• Implement procedures to ensure information is consistent across all

channels• Agree how to work with partners (public, provider and voluntary

sector) in the provision of information and other support that people will be signposted to

• Work through and agree the interface with services providing low-level interventions, or enablement services and other ‘fast track-able’ or crisis support

• Review triggers for assessments

Breakdown of activities for TOMAssessmentThe traditional care assessment and management process will need to be redesigned to enable transformation. Assessment includes determining eligibility and the personal budget amount which typically

involvesdeveloping an operational Resource Allocation System (RAS) and defining

the roleof self-assessment. This may have an impact on current role definition

and teamstructure of social worker/care managers.

• Decide on approach to self-assessment & when to make citizens aware of their budget

• Develop assessment questionnaire• Develop Resource Allocation System• Refine financial assessment• Decide how to validate and risk manage assessments• Put appropriate risk management arrangements in place• Ensure integration with other assessments (CAF, other funding

streams etc) - minimum signposting role• Adapt back office systems to support these functions• Define the role of social workers & care managers and changes to role

descriptions and team structure• Develop training plan

Breakdown of activities for TOMIndicative Personal Budget Calculated

At this stage the person is informed about their personal budget and about any appeals process.

• Decide how best to communicate this information• Agree processes for approving indicative personal budget allocations• Decide appeals process• Agree policies for exceptional and transitional allocations • Adapt back office systems to support these functions

Breakdown of activities for TOMSupport planning

The traditional care assessment and management process will need to beredesigned to enable self-directed support. People can use any

combination of resource (third sector, friends, family, social workers, care managers) to

developtheir support plan. The council will retain a role to risk assess and approve support plans.

• Decide maximum and minimum levels of assistance to be offered and by whom

• Utilise existing resources in the community• Develp new support planning approaches to offer genuine choice and

stimulate creativity while managing risk• Consider boundaries for what personal budgets can be spent on• Define the role of social workers & care managers and changes to role

descriptions and team structure• Develop training plan• Adapt back office systems to support these functions

Breakdown of activities for TOMAuthorisation & validation

The council will continue to retain a role in ensuring that support plans will meet the identified needs of individuals and that their legal

responsibilities are met. To do this there needs to be an effective process to agree

support plans.

• Agree a process for the authorisation of support plans • Develop guidance for social workers to negotiate changes to support

plans, in line with support planning guidance

• Agree an appeals process if people do not agree with social workers when determining the support plan

Breakdown of activities for TOMGo Live/expansion/optimisation – service implemented and

commenced

In a self-directed support system, citizens can choose to control their personal budget in a variety of ways. There will also be the need to ensure peoplehave the assistance they need to secure the support specified in the support plan.• Agree how to maximise the resource deployment options - direct payment; a

representative, a legal trust, an independent support organisation or a provider manages the funds on their behalf; services provided or procured by the council; or a combination of these methods

• Agree the control mechanisms over each method • Develop processes for supporting these different types of personal budget• Design structure and standard content of contract between the person and the local

authority• Decide which aspects of organising support the council will support and which aspects

it will rely on external providers for role of local authority under self-directed support• Decide what parts of the cost of organising support appear within the personal budget• Identify and consult with current or potential organising support providers• Decide if the cost of organising support should be included in a personal budget• Creation of resource directory• Define the role of social workers & care managers and changes to role descriptions and

team structure• Develop training plan• Adapt back office systems to support these functions

Breakdown of activities for TOMMonitor & review

Quality assurance and review will be different under transformation. This includes the development of outcome based reviews, ensuring

support plans are being delivered and also responsibility for understanding how

personal budgets have been spent. The relationship with monitoring suppliers’ quality will

also be different if this support was commissioned by individuals. • Develop a process to monitor outcomes and a basis for agreeing

individually how often support plans will be reviewed• Produce review forms/templates/guidance documents• Develop risk management framework to help ensure that the level of

scrutiny undertaken on how individuals spend their budget is appropriate to risk

• Decide on level of quality assurance for providers• Define the role of social workers & care managers and changes to role

descriptions and team structure• Develop training plan• Adapt back office systems to support these functions• Collate evaluation information to inform the next phase

Breakdown of activities for TOMUnderstanding needs and commissioning

Under a self-directed support system the council no longer has direct control over where a significant proportion of the adult social care budget is spent. The market will be responding to individuals choosing what services

theyreceive as well as any contracts that the council chooses to put in place. The

roles ofstrategic commissioning, contracting and contract monitoring will

fundamentally change. • Find ways to learn about what people want• Develop better information on needs and future demand including self-

funders• Explore how and how much the council can influence the market and

where it will get its intelligence about what people want to buy from• Map market in area• Consult with providers• Decide what's in house & what's commissioned• Charging policy• Strategy for existing contracts• Adapt financial, care management & back office systems to support

these new functions

Breakdown of activities for TOMBack office services

Allocating spend and procuring services on an individual basis will requirefundamentally different back office processes and systems. This will

include IT facilities as well as auditing, invoicing and payment processing. Assisting individuals in managing their finances, including through third sector

providers will also require different processes. All these processes will need to be

scalable i.e. some processes will work for small numbers of people but will be

impractical for large numbers. In addition, different systems will be required to support

both back office processes and delivery of care services.. • Decide back office processes for supporting different types of personal

budget (e.g. direct payment, provider facilitated, nominal budget for procuring in-house services, combination)

• Refine and simplify direct payments processes• Undertake analysis to better understand current spend, service user

numbers and unit costs• Adapt financial, care management & back office systems to support

these new functions• Develop risk management framework to help ensure that the level of

scrutiny undertaken on how individuals spend their budget is appropriate to risk

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

How do we define the success of the

Transformation agenda?

• Does our definition of the success of transformation need updating?

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

Getting started – defining a limited launch in Phase 1

•Who will be involved in the pilot?– Client group?– Transition / new clients / annual review / all?– Other factor (e.g. locality / type of provision / team)?

•Size?

– How many clients will be involved in the pilot?

•Speed?

– How quickly will clients be brought into the pilot?

•What are the key issues for each of the elements of transformation when running a pilot?

Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

Next steps

• Report to DMT

• Move to Blueprint stage

• Communications