Adult Social Care Transformation and Supporting People

SHIP ConferenceFebruary 4th 2010

Helen DuckworthLondon Borough of Brent

ASC Transformation Team

New Model

Advice and Information

Council FundedPersonal Budget Self Funders

HELP TO ‘PLAN’

HELP TO NAVIGATE MARKETPLACE AND SECURE SERVICES

ADVICE AND SUPPORT IF THINGS GO WRONG

Ensure QUALITY & CHOICE of SERVICES

Individual Direct LA held Service Fund OR Payment (£) OR budget

OWN RESOUCRES££

Assessments

Residents in Need

DEVELOP ACCESSIBLE UNIVERSAL SERVICES

What good looks like……………………….

Universal Information and

advice

Targeted preventative

support

Self Directed Support and

Personal Budgets

Support in planning,

purchasing and managing care

Transformed System of Care and Support

Independent, Safe and Valued livesEasy access to one stop advice and info Advice if things go

wrongHelp to plan Good

support plans Services are flexible and responsive

Less long term intensive support Managing risk and keeping safe Everyone empowered to make informed choices Transparent resource allocation Co-production

A diverse high quality care marketAll sector workforce skilled and trained

Sustainable finances supporting prevention, maximising valueUser and carer involvement embedded

Systems support high quality services, dignity and safety

Understanding the terms

How are local authorities measured?

• Effective Partnerships with people using services, carers and other local people

•Self Directed Support and Personal Budgets

•Prevention and Cost Effective Services

•Information and Advice

•Local Commissioning

Targets for the Brent ASC transformation programme

•To support people to achieve independence and control over their lives•50% less people living in Residential Care by 2010•50% of our service users on Self Directed Support by 2011•A significant increase in Direct Payments•A transparent sustainable resource allocation system •Increase in the use of Extra Care Sheltered Housing and other alternatives to residential care•Single Point of Information and Advice about Care Services•One service regardless of age for those who need Adult Social Care •Re-ablement for all who can benefit

7 transformation work streams

1. Self Directed Support

2. Modernising Day Care

3. Modernising Transport

4. Re-designing Assessment and Care Management

5. Maximising Staff Efficiency

6. Developing alternatives to Residential Care

7. Developing effective commissioning

Where are we now? •Re-design of Assessment and Care Management completed•Over 600 people receiving Direct Payments with 100+ Personal Budgets in progress•Staff Guidance and Training and Procedures•Resource Allocation•Developing SDS for Carers- co-production with carers •Limited work with SP providers•Developing Brokerage, Information and Advocacy•Working with Home Care Providers – introducing flexibility and re-enablement within existing contracts•Re-modelling transport and day services •Introducing Intermediate Care and Re-ablement • Re-modelling Community Equipment Stores •Market development and Service user involvement•Internet developments- Slivers of Time •West London Commissioning

Personal Budgets

•One part of Transformation- not everyone will get a personal budget•Self directed support is popular, cost effective and achieves better outcomes•Nationally more than 40% of Personal Budgets are for Older People •Focuses on achieving outcomes rather than services•System in which publicly funded are brought ‘alongside’ private payers (in developed market)•Transparency and portability- tell people the costs of their services- they start asking questions and making choices…..

Targets for SDS in Brent

Client Group SDS at Feb 09 Target for March 2010

Target for 2011

Physical Disability

133 252564

Learning Disability

123 233645

Mental Health 147 279 436Older People 96 182 1512Total 499 946 3157

Information/Advice/

Guidance

SDS Operating Model

1st Contact/ Screening

Assessment

6 Weeks Reablement/

Early review

Immediate Service/Early

Review

Self Directed Support and

Resource Allocation System (RAS)

Support Planning

Brokerage

Support

Delivery and Budget Payment

Review

Transformation Challenges•Culture Change for citizens and staff and partners•How much of our budget should go into Universal Services, how much to individuals? •Quality Assurance of a dispersed market- avoiding micro mgt•Safeguarding in a dispersed market •Getting feedback from service users•Providing information about services – role of internet/advocates/partners•Developing the market – people will want traditional services until an alternative is there•An alternative may be very attractive- increase in demand? •Managing change in in-house services•Expanding the resources- making use of social capital, supported living, extra care housing, technology to support people at home

Provider Implications

1. Impact for People using your services

Offered Personal BudgetsWhat role will you play- support, advice, advocacy, brokerageConflicts of interest? Support to help people employ their own staff- training, pay-roll etcRange of services available for them to choose

“”It is the principles of choice, voice and control which should underline what specialist housing and service providers deliver” (Denise Platt – Housing 21 - Building Choices part 2)

Provider Implications 2. Impact on Your Organisation

Increased use of information advice and advocacyPreventative Services Services for the whole community Different Services – participate in ordinary lifeFinancial Arrangements – Grants vs Contract Relate to service user not commissioner Outcome based support Changing role of commissioners

Growth of Personal Care options

•Service delivery model• Staffing levels• Role of scheme manager•Flexibility in deployment of financial and staff resources?• Duty of care?• Risk and safety issues?• Scheme sustainability• Sustainability of communal spaces & facilities• Work in partnership with local authorities

Housing Provider Implications

Provider Implications- Opportunities

• Respond to gaps in the market- new, more varied preventative services

• Some block contracts offering wider range of services for very specialist and universal services

• Opportunity for new providers• Private purchasing likely to increase as criteria and

charges made by L.A’s increase? • Improved relations with service users – less rigid

timings and activities with personal budgets –appealing to excluded groups

• Getting to know the whole person- more focus on outcomes- staff and user satisfaction

• New ways of Working- IT opportunities • Opportunities for joint purchasing by groups of

users? (Up2us project – HACT)

Provider Opportunities- Not just home care and personal assistants

•Brokerage•Support Planning •Advice and Training for Self -Employed staff •Direct Payments advice •Holiday cover •Register of staff willing to work as PA’s•Managed accounts

•Support with outings and leisure •Social Activities•Small repairs•Gardening•Travel Support •Housing Support•Living a “normal life” •Specialist support e.g. dementia

Provider Strategies

1. Focus on outcomes, gather outcome data and tell your success

2. Respond to what you know people want - re-think support work, people need help to get into work, make friends, learn new skills

3. Identify your Unique Selling Points

4. Build Personal Budgets into your systems- ring fence peoples budgets, core services and add-ons

5. Calculate costs accurately and develop a menu of services

6. Build Personal Assistance into your offer

7. Get everyone involved- finance staff, front line workers, board

8. Get involved with local people and Local Authority (co-production and phased introduction)

9. Share what you learn

Further Information

• www.in-control.org.uk

• www.csip.org.uk

• www.sds4me.org.uk

• www.Shop4support.com/partner-programme

• www.sliversoftime.info

• Implications of Individual Budgets for Providers (OPM August 2007)

• Commissioners and Providers Together: Citizens at the Centre (Andrew Tyson, In Control , June 2007)

• Local Authority Circular (DH)(2009)1: Transforming Adult Social Care (and links in this document to many useful articles)

• Making it Happen-Lessons learned on the introduction of IBs in a Provider Organisation (Jill Parker, KeyRing, 2008) (on InControl website)