Transforming Social Care

Together Trust

14th July 2008

The wider context

Social care is a rationed service Demand will always outstrip supply Allocation of these resources increasingly open to

scrutiny nationally and locally Historically this allocation was relatively local and

informal This led to a ‘postcode lottery’ Increasing number of legal challenges around

individual decisions

1998 White Paper ‘Modernising Social Services’

Established the notion of FACS– Councils should have ‘clear rules about who can get help’

so that ‘everyone in an area gets treated fairly’

Led to publication of eligibility criteria based on need and risk to independence

– Critical – Substantial– Moderate– Low

What happened?

Did achieve consistency within councils Achieved equity in terms of access to services such

as intermediate care Some evidence that professionals tailored their

assessment to make sure people met eligibility But if you rule people in you also rule people out

especially– Self-funders– People with low level needs

Moved towards outcomes

2006 White Paper ‘Our Health Our Care Our Say’ identified seven outcomes:

– Quality of life– Exercising choice and control– Making a positive contribution– Personal dignity and respect– Freedom from discrimination and harassment– Improved health and emotional well being– Economic well being

Now used by CSCI as basis for assessment

Putting People First

“Local Authority leadership accompanied by authentic partnership working to create a high quality care service which is fair accessible and responsive to individual needs”

Transformation Agenda

Joint Strategic Needs Assessment Supporting a Community Strategy Commissioning that incentives quality provision Promotes innovation in the third sector (including

social enterprises) Universal advice advocacy and information service

(irrespective of eligibility) Greater emphasis on self assessments More individual budgets (including Health) Increased use of telecare

System Transformation

Family members and carers as care partners Retail model for equipment Support for at least one local user led organisation to

promote ‘voice’ LA to minimise risk of abuse or neglect Improved workforce planning Better integrated working with children’s services Championing the rights and needs of all vulnerable

adults and older people

Quickheart

Consultancy company under the umbrella of the Dept of Health

Undertook a survey of how people get in touch with Adult Social Care

Looked at the contact centre and website specifically

Found a number of challenging issues

Chastening Findings

Overall great confusion and conflicting points of view about what adult social care is and how it is delivered

Use of web is limited and awareness of contact centre is also minimal

Compounded by very real fear that social services represents

– Loss of self respect and identity– Failure of ‘care’ and loss of control/choice– An emergency option– Loss of home/loss of dignity

And then

People therefore are in denial that they ‘need care’ as they fear what ‘social care’ represents

Only when a crisis occurs do they seek help– Reinforcing perception that social services represents a

failure for the individual – embarrassing and undermining– Care becomes question of survival rather than choice (and

something loathe to pay for)– Visible signs of care become symbols of that new position

and status

FACS v Personalisation

Professional assessment of need

Categorisation Standardisation Consistency of

treatment Explicit decision making Centralised purchasing

Self assessment Self determination Choice Individual differentiation More arms length

accountability for committing expenditure

Commissioning for outcomes

Our Challenge

To shift from:– A stigmatised and

selective system– Based on criteria – Using difficult

language that alienates many

– That selects people out

To:– A more universal

system– Focusing on

independence health and well being

– Valued and used by a wider section of the community

In Control

Personalised budgets is a key to this transformation

We want to empower people to have more say over their care

We want to make it more mainstreamed less marginalised

We want to work with you on that That is what this day is about