What is happening in Britain?

Personalisation of Social Care

What happens in Britain?

Four countries England, Scotland, Wales and N. Ireland

Hospitals have closed NHS Campuses are closing Still lots of out of county placements Commissioning transferred to local authorities Mixed economy

Voluntary Sector, Private sector, some public sector

Mix of models Residential care, Supported Living, Self Directed

Support

Valuing People 2001

“To improve the lives of people with a learning disability and their families and carers, based on their rights as citizens, social inclusion in local communities, choice in their daily lives and real opportunities to be independent.”

Valuing People 2001

Valuing People Now 2008

What Valuing People Now is about

Improve the way we give services to people using them

Making sure change happens

Improve the services offered to people

Personalisation

What people do

Health

Housing

in Control

http://www.in-control.org.uk

Putting People First 2007

A shared vision and commitment to the transformation of Adult Social Care

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/DH_081118

Why Personalisation?

The present system is not working well for several reasons

It does not control costs well, especially when needs are perceived to be more complex.

It limits creativity, innovation and community development.

It discourages family and community support solutions

It does not result in a good alignment between individual level of needs and level of service.

But most fundamentally, by not telling people what level of funding they have available, it stops disabled people from deciding for themselves how they want to be supported

Personalisation - No longer if but how and when

SDS is a new model of social care. SDS is about individuals receiving a personal

budget that they control to meet their own care needs, rather than the current service led approach.

It has the potential to improve the lives of vulnerable people by offering them more choice and control.

SDS is planned to be rolled out nationally by 2012.

Social Care vs. SDS

Social Care Self Directed Support

Vulnerable people need professional

support

Vulnerable people should control their

own lives

Existing services work well

Support should be individually tailored

Money is safest in the control of the state

Money should be close to the individual

Family and friends are unreliable

Family and friends have a vital role to

play

Lessons from other Sectors, Greater Consumerism Means

Constantly innovating

Constantly improving product

Better quality

Better price

More individualised

Current resource allocation system

SDS resource allocation system

Options for receiving SDS with an individualised budget

Direct PaymentDirect Payment

(agent)Direct Payment

(trust)

BrokerIndividual Service

FundCare Manager

What is Service Brokerage?

Service Users + Financial Allocation

Informal Support

Provider Organisation 1

Provider Organisation 2

Provider Organisation

3

Service Broker

In Control sees Brokerage as a set of functions

Assisting the person to develop a vision of how he or she wants to live

Reviewing, preparing and/or identifying indicative costs of creating and implementing a support plan

Clarifying the person’s needs and expectations, including, in the light of the local authority’s assessment, eligibility criteria under Fair Access to Care

Identifying and applying for funding from all government and non-government sources

Supporting the Fair Access to Care appeals process if required

Identifying and enabling the person to access community resources

Assisting with funding negotiation with commissioners

Liaising and negotiating with support providers

Monitoring and evaluating support

Modifying existing supports or develop new ones

Mediating and resolving problems (as directed by the person)

A report on in Control’s Second Phase – Evaluation and Learning 2005 - 2007

Impact on the Market?

Good quality, flexible, innovative providers will prosper

Poor quality providers will fade Expectation that quality will go up and prices go

down Potential for development of a lot of informal

arrangements Marketing directed at consumers will be developed There will be opportunities for individual solutions

Seven steps to being

1. My money – finding out how much

2. Making my plan

3. Getting my plan agreed

4. Organising my money

5. Organising my support

6. Living life

7. Seeing how it worked

The Choice Support group at a glance

Current turnover circa £32.5 million

Support 750 people

Employ 1300 staff

Operates in ………………….

Wakefield Nottinghamshire Stockport Oldham Leicestershire Bedfordshire Milton Keynes Buckinghamshire Hackney Haringey Greenwich Lewisham Southwark Lambeth Bromley Sutton Merton Hampshire Southampton Portsmouth

Preparation 2004 - 2008

7 presentations by ‘in Control’, Paradigm managers (40+)

9 Managers attend Paradigm Brokerage for Change course

CEO joins ‘in Control’ CEO groupNew bespoke individual accounting

system developed and installedManagement re-organisation

Formula for identifying supportIf n ≠ 0

α = + x + y + (n-Σσ) + σ

Key

α = % split to be applied to staff costs

G = Grade

h = Shared service support hours per week (i.e. total support hours less all 1:1 & 2:1)

x = 1:1 hours per week

y = 2:1 hours per week

n = Night waking hours (70) shared between those individuals requiring

σ = Sleep in equivalent hours (19) shared between those individuals requiring

H = Total service support hours per week (inc. night support)

Σ = Sum of

(G/ΣG) x h

H

Dealing with resistance

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new”.

Machiavelli

First steps in individualising services and reducing costs

Lincolnshire – RAS 4

Individual services for people who present significant challenge

What’s happening now?

Direct Payments SupportFinancePersonnel

Free Service Brokerage

Total transformation of a £7 million contract

Challenges

Managing traditional services alongside new Ability to change organisational culture Ability to change systems and structures Ability to make desired savings Loss of control Loss of business Serving many masters - responsiveness Workforce transition Marketing – looking both ways Total transformation of funding of social care required To make better use of all of the available money in the

system

Opportunities

Those organisations that are able to respond positively can expand their business.

Diversification – HR; Payroll; training; etc. Move away from contracting “culture” and

reliance on “good relationships” with those in power.

The credit crunch The opportunity to abandon the current failing

social care system for one that is fairer, more responsive and delivers what the customer wants