PersonalisationPERSONALISATION

Challenges and opportunities for supported employment

Kathy Melling and Paul Wilson

Introduction

 Our six themes for today:

1. What do we mean by personalisation?

2. The personalisation journey in UK

3. The challenges for service users, providers and commissioners of supported employment

4. How BASE has been responding to those challenges?

5. What we`ve learned - BASE`s current position

6. The key issues for Irish stakeholders in the context of New Directions

Personalisation means thinking about public services and social care in an entirely different way – starting with the person rather than the service. It will require transformation of the way we deliver public services.

Julie Jones, Chief Executive, SCIE

Personalisation

Where did the idea come from

• Social work values

• Government agenda of choice and control

• Disabled people peoples’ movements

What is personalisation?• Begins with the person, not the service• Recognises a person’s strengths, preferences, networks

or support, friendship etc.• The individual is best place to make decisions about

their life• Access to information and advice• Irrespective of whether self-funded or publicly funded• About giving people choice and control over their lives• Making sure that individuals live life as they want

What personalisation is not

• A completely new idea• Just about giving people individual budgets• Only for people eligible for Government funding or those

needing traditional services only

What it does mean• Finding new collaborative ways of working and developing

local partnerships, which produce a range of services for people to choose from and opportunities for social inclusion

• Tailoring support to people’s individual needs

• Recognising and supporting carers in their role, while enabling them to maintain a life beyond their caring responsibilities

• Access to universal community services and resources – a total system response

• Early intervention and prevention so that people are supported early on an in a way that’s right for them

Personalisation – 4 elementsCommunity facilities and services that we all use, e.g. transport, leisure, health, education, housing and access to information and advice

People as participants in their communities, friendships and family relationships - individuals with lives and relationships

Support that’s available for people to stay independent for as long as possible

People choosing who provides their support and what form that support takes, and controlling when and where those services are provided, rather than being expected to fit in with what’s already on offer

What’s it all about?Personalisation

Self directed support

Personalbudgets

Direct payments

The process by which state provided services can be adapted to

suit you

Support that is determined and controlled by you, based on an

assessment of need by the state. (Includes receiving cash, spending on services that meet your needs,

to choosing which hospital you wish to attend)

An indicative amount of money that can combine

several funding sources that you can use to purchase services, from the public, private or voluntary sector

A cash payment paid directly to you so you can acquire your own services, rather than having

them delivered by the council

Individualbudgets

Like an IB but solely made up of social

care funding

Personalisation journey in the UK

Key themes:•Clear policy intent across Government, but intent is only benefitting some people•Concentration of activity has been on PBs and RAS methodology•Inadequate attention to other system changes•Inability to “braid” funding•Varied life and satisfaction outcomes across service-user groups•Employment often not considered during assessment•Impact of austerity measures

Personalisation journey in the UK

• In Control• Think Local Act Personal (TLAP)• Department of Health – Direct Payments, Jobs First,

personal health budgets• Office for Disability Issues – Right to Control• Liz Sayce review of specialist disability programmes• Department of Education – Special Educational Needs

and Disability reforms• How personalisation is being interpreted locally

The challenges to providers & service users

Good supported employment is:• A genuine partnership• Independence, choice and control• The six stage process

Personal budgets mean:• No change for customers• Significant change for providers &

commissioners

The challenges to providers & service users

The three challenges posed by the marketplace:

1. Pricing challenges

2. Marketing challenges

3. Delivery challenges

The challenges to providers & service users

1. Pricing Challenges

• What do commissioners want to buy and how do they want to buy it?

• The challenge of the hourly rate • ‘Working hard’ to find ‘the right job’• The service user`s `end to end` journey• Predicting progress• Fire-fighting

The challenges to providers & service users

2. Marketing challenges

• Selling directly to customers

• Differentiation (M&S or Poundshop)

• Price differentials

• Selling more than job starts

The challenges to providers & service users

3a. Delivery challenges

The context:• A professionalising sector• Inspection, QI, payment by results• The art of balancing risk, independence,

learning & progression

The challenges to providers & service users

3b. Delivery challenges

• A retail model• Managing fluctuation in cases• Managing work flow & overcapacity• Economies of scale• The risks and rewards of an agency model

How BASE is responding to the agenda

• Discussion workshops for members• BILD guide – Personalisation and Supported

Employment• Mapping through member intelligence• Engagement with Think Local Act Personal

(TLAP)• Right to Control in Stockport – My job, My choice• Work with SUSE • Support to members

The challenges for commissioners

The need to work proactively with commissioners

Capacity-building work with the Scottish Union of Supported Employment (SUSE) …..

The challenges for commissioners

The Commissioning Matrix developed for SUSE

The consultation and research suggest that the options for commissioners revolve around two central themes:

1.Control: the extent to which a local authority intends to manage the marketplace in which supported employment is traded;

2.Pricing: the way the market defines and prices the supported employment service which is traded in that marketplace.

The challenges for commissioners

The Control Axis

The control axis describes to what extent the commissioner intends to manage the marketplace.

At one end of this continuum is a free market.

At the other end of the continuum is the block contract

Somewhere near the middle is the Preferred Provider scheme.

The challenges for commissioners

The Pricing Axis

The pricing axis describes how a local authority defines what is being bought and sold.

At one end of the continuum is payment by occupancy.

At the other end of the continuum is payment by results.

Along the continuum are the degrees to which what is being purchased is defined by milestones.

The challenges for commissioners

The Key Questions Framework

1. What presumption of employability do we hold for

service users?

2. What are our strategic considerations?

3. What is our approach to choice?

4. How do we want to manage or influence

performance?

5. How, if at all, do we want to influence quality?

Draft position statement on personalisation and personal budgets

• Fully support the move to personalisation• Supported employment has always been a fully personalised model of employment

support• Not simply about giving people a personal budget• Professionalisation of the sector is at risk in a wholly individualised retail model• Need a different approach to how it is applied to employment support• Either an up-front fee to get a job, and lower fee for on-going support – a one-off

process or transaction that delivers longer term savings; or a strategic approach to commissioning the service.

• There is a need for commissioners to understand what evidence-based best practice is to get those furthest away from the labour market jobs.

• There is a need for disabled people to understand what good employment support looks like if they are using their personal budget to purchase employment support.

• There is a need for an evidence-base of the genuine costs to deliver supported employment using personal budgets.

• There will always be infra-structure costs as not all activities of supported employment can be attributed to one particular person using a service. There is a need for an evidence-base of the percentages of what that this will be.

Key issues for Irish stakeholders

• Personal budgets do not guarantee personalisation

• Personal budgets need to be powerful enough to achieve multi-service integration

• Understand the barriers to achieving personalisation through New Directions

• Collective purchasing & Value for Money issues• Supported employment infrastructure costs• Transition arrangements

Summary

 Our six themes covered today:

1. What do we mean by personalisation?

2. The personalisation journey in UK

3. The challenges for service users, providers and commissioners of supported employment

4. How BASE has been responding to those challenges?

5. What we`ve learned - BASE`s current position

6. The key issues for Irish stakeholders in the context of New Directions

Personalisation & Supported Employment

Questions & discussion points