introducing personalised budgets for persons with ... · a workshop event was held with the...

Introducing Personalised Budgets for Persons with

Disabilities in Ireland

Report by:

Alpha November 2017

2 27 11 17 Alpha Personalised Budgets Report Final

TASK FORCE ON PERSONALISED BUDGETS

Workstream 5 – Governance & Accountability

Alpha Framework Model Options Report

Executive Summary: The Task Force on Personalised Budgets (PBs) primary objective is to make recommendations on an approach and suggested implementation plan for a National system of PBs for Government consideration. Alpha were commissioned by the Department to support the delivery of Workstream 5’s goals and specifically to work on determining suitable administration and governance framework model options for personalised budget delivery. Extensive research undertaken by The National Disability Authority’s found:

• There is no one approach to implementing a system of personalised budgets that can be adopted from another jurisdiction

• Most personalised budget systems emerge over time, as approaches are tried and tested

• The way systems have evolved depends a lot on the economic and social context of the country in question

• There is very little evaluation of how one approach performs against another to give a ‘best’ approach

Alpha conducted additional research on International PB models and also reviewed thirteen different National application and governance systems to extract learning and good practice, that may be applicable to an administration and governance model for PB in Ireland. Key assumptions that Alpha were advised to make in undertaking this work were:

1. Agreeing eligibility and entitlement criteria outside of Alpha’s scope 2. Assume that Persons could apply for full range of ‘areas of personalised budget expenditure’ 3. Un-bundling of funding from current service provision is outside Alpha’s scope 4. The proposed personalised budget models should be capable of running alongside existing current

HSE Disability services (assume an uptake of 10 -15% in PB) and be capable of being extended to other service user groups and run as a separate agency in the future

The Alpha team initially worked on developing a very detailed ‘generic’ based personalised budget administration and governance system. This encompassed a wide range of model and pathway options and was used for discussion and deliberation with the Department and other workstream leads. A series of five model options were then developed and this was then finetuned into three framework models that are presented in this report, namely:

• Model 1 – PB Application and Governance Prescriptive Approach

• Model 2 – PB Application and Governance Alpha LEAN Approach

• Model 3 – PB Application and Governance Light Touch Approach


Each model sets out 5 key stages for the application and governance of personalised budgets in an Irish context, which are:

Stage 1: Information on Supports Options – the Person engages in an information and briefing stage to determine if a PB is likely to be desirable for them

Stage 2: Application – the person progresses to apply for a personalised budget and assessing Practitioner discusses an outline Personal Support Plan (PSP) and advises on availability of supports and funds for PB

Stage 3: Support & Planning – queries raised by the Person are addressed and payment options discussed

Stage 4: Implementation and Accountability – the Person decides on their preferred payment model option for PB. The Person finalises their PSP, in consultation with Liaison Officer, Service Provider or Broker.

Stage 5: Review & Governance – Management of review and reporting mechanisms and ability to amend PB where required

Each model option considers three payment options that the Person may choose from:

1. Self-Managed Fund 2. Co-managed with HSE/Service Provider 3. Broker/Intermediary Managed

Detailed process maps and descriptions are presented for each model together with a SWOT analysis. Alpha looked at the governance and administration for each model and has set out a range of governance parameters for consideration. Work was also undertaken to set out the cost element differences for each model to feed into the financial sustainability review. A series of three tables – showing model differences, governance parameters and cost element comparisons for each model are shown in the report for review and consideration by the Task Force. The Person referred to throughout this process represents the person with a disability and/or his/her support network e.g. advocate or chosen representative. In certain circumstances a family member, advocate, guardian, decision-making assistant, co-decision-maker or decision-making representative may be nominated to act as fund manager and would assume the associated reporting and accountability responsibilities. In developing the proposed framework model options for the administration and governance of a PB, Alpha considered a potential ‘future state’ map and sets out how this may look in the report, within the parameters and scope of work outlined. Whilst developing suggested governance structures and performance review parameters, Alpha applied the concepts of proportionality and a ‘phased governance’ introduction. These were applied to all models to align with differing levels of support funding and to allow for reduced levels of governance once a PB option, selected by Person is in place and operating satisfactorily. Recommended training for Persons with Disabilities who are interested in taking up the option of a personalised budget are included within the report. A workshop event was held with the Workstream leads, at the Department to discuss draft versions of the framework models for PB. These were also presented at the recent Strategy Group meeting. Feedback from both of these have been factored into this final report and presentation of the three framework model options for the administration and governance of personalised budgets in Ireland.


Table of Contents Executive Summary: ......................................................................................................................................... 2

1 Introduction & Scope ........................................................................................................................... 6

2 Assumptions ......................................................................................................................................... 7

3 Approach & Methodology .................................................................................................................... 8

3.1 Approach .......................................................................................................................................... 8

3.2 Project Governance .......................................................................................................................... 8

3.3 Background Information & Detailed Research: ............................................................................... 9

3.4 Generic Framework Model Development ...................................................................................... 11

3.5 Framework Model Assumptions .................................................................................................... 12

3.5.1 Person ..................................................................................................................................... 12

3.5.2 Support and Resource Administration Roles ......................................................................... 13

4 Governance in the Administration of Personalised Budgets ............................................................. 13

4.1 Overview ........................................................................................................................................ 13

4.2 Governance at each Stage of the PB Process ................................................................................. 14

4.2.1 Information on Supports Options & Application Stages ........................................................ 14

4.2.2 Support and Planning Stage ................................................................................................... 14

4.2.3 Implementation and Accountability & Review Stages ........................................................... 15

4.2.4 Future State ............................................................................................................................ 16

4.3 Appeals Process .............................................................................................................................. 16

5 Framework Model Overview .............................................................................................................. 17

5.1 Introduction ................................................................................................................................... 17

5.2 Future State .................................................................................................................................... 17

5.3 Framework Model Options – Comparison Table ........................................................................... 17

5.4 Governance Summary Table .......................................................................................................... 18

5.5 Macro Overview Map of Personalised Budget Models .................................................................. 18

6 Framework Model Options for the Administration & Governance of PBs ........................................ 26

6.1 Model 1 - PB Application & Governance Prescriptive Approach ................................................... 26

6.1.1 Information on Supports Options .......................................................................................... 26

6.1.2 Application ............................................................................................................................. 26

6.1.3 PB Support Planning ............................................................................................................... 27

6.1.4 Implementation and Accountability ....................................................................................... 28

6.1.5 Review of Personalised Budget .............................................................................................. 31

6.1.6 Strengths & Weaknesses Analysis .......................................................................................... 31

6.2 Model 2 – PB Application and Governance Alpha LEAN Approach ............................................... 33


6.2.2 Application ............................................................................................................................. 33






6.3 Model 3 – PB Application and Governance Light Touch Approach ............................................... 37


6.3.2 Application ............................................................................................................................. 38





6.4 Assessing Practitioner and Liaison Officer Roles ............................................................................ 42

7 Opportunities & Threats for Personalised Budgets ........................................................................... 42

8 Appeals Process .................................................................................................................................. 44

9 Training of Persons Applying for a Personalised Budget ................................................................... 45

10 Financial Sustainability ....................................................................................................................... 46

Appendix 1: Documents Provided by Department used as input to the Development of Framework Model Options ............................................................................................................................................ 49

Appendix 2: Model 1 – PB Application and Governance Prescriptive Approach ....................................... 50

Appendix 3: Model 2 – PB Application and Governance Alpha LEAN Approach ....................................... 50

Appendix 4: Model 3 – PB Application and Governance Light Touch Approach ....................................... 50


1 Introduction & Scope As part of the Programme for a Partnership Government, a Task Force on Personalised Budgets (PBs) was established. The primary objective of the Task Force is to make recommendations on an approach and suggested implementation plan for a national system of personalised budgets for Government consideration. The aim is to give people with disabilities greater control, independence and choice in terms of obtaining HSE-funded personal social services and supports. The overall objectives of the Task Force are to:

• Submit a report setting out the evidence, analysis and preferred options in relation to each of the matters in the Task Force Terms of Reference;

• Recommend a proposed approach and implementation pathway with timetable for delivery;

• Provide an outline of any legislative changes that may be required. The work of the Task Force has been divided into 5 key workstreams/phases of:

1. Discovery phase 2. Eligibility/Resource Allocation 3. Financial Sustainability 4. Supports to Apply for & Administer Personalised Budgets 5. Governance & Accountability

Alpha were commissioned by the Department to support the delivery of Workstream 5 of the Personalised Budgets Task Force Work Plan focused on the development of an administrative and governance framework for a single national coherent system provision of personalised budgets. Alpha’s brief is specifically to work on suitable administration and governance framework model options for Personalised Budget delivery. The key deliverables are to submit a report to the Department setting out:

1. A small number (3-4) of framework options for the administration, delivery and payment of a personalised budget scheme in the Irish context including possible governance and oversight systems.

2. Quality assurance or regulatory controls in relation to these framework options. 3. Insofar as possible, information on estimated or relative costs of the framework options for the

different frameworks described. A broad description of each administrative and governance framework will be provided along with the advantages and disadvantages and strengths and weaknesses of each. The options outlined should:

• work effectively for persons who are eligible for HSE-funded disability supports and services in the first instance, and

• be capable of being extended to other service user cohorts or other Governmental funding streams in the future.

A significant body of national and international research had already been undertaken by the National Disability Authority and the Health Research Board. This included, reviews of international practice and approaches to the provision of personalised budgets in different jurisdictions. The National Disability Authority’s research findings note the following comments about personalised budgets:

• There is no one approach to implementing a system of personalised budgets that can be adopted from another jurisdiction


• Most personalised budget systems emerge over time, as approaches are tried and tested

• The way systems have evolved depends a lot on the economic and social context of the country in question

• There is very little evaluation of how one approach performs against another to give a ‘best’ approach

The HRB’s international research of other jurisdictions identified three different models of personalised budget delivery as shown in Table 1 below:

Table 1: Three Model types of PBs from HRB Research Alpha’s focus has been to identify options for the administration and governance of personalised budgets that would be most relevant within an Irish context.

2 Assumptions The work of the Task Force involves multiple workstreams working collaboratively and in parallel to meet a tight project timeline. Accordingly, to progress the Governance and Accountability workstream work package, Alpha were advised to make the following key assumptions:

1. Agreeing Eligibility and Entitlement criteria is outside Alpha’s scope of work – Alpha is to assume that all Persons currently eligible for HSE-funded supports and services would be eligible for a personalised budget (PB)

2. ‘Areas of Personalised Budget Expenditure’ – Workstream 2 (Eligibility/Resource Allocation) is working on the scope of services and supports to be covered by personalised budgets in a first phase of rollout. Alpha are to assume that persons could apply for the full- range of ‘areas of personalised budget expenditure’ and framework options developed on this basis. The initial phase of the roll-out of PB is likely to start with a more limited selection of supports that a person can purchase with a PB and over time develop into the full range of ‘areas of Personalised Budget Expenditure’. The framework models proposed must cover this transitionary phase as well as the likely future state of PBs.


3. Resource Allocation – this is being worked on by Workstream 2 and is outside Alpha’s scope of work. Alpha is to assume that Eligibility and assessment of needs will be addressed via mechanisms and processes to be agreed by Workstream 2.

4. Availability of support services for persons to purchase using their personalised budget – the un-bundling of funding from current service provision is outside the scope of the Task Force and Alpha. For the purposes of the Governance and Administration work, Alpha is to assume that an un-bundling mechanism will be developed at a later stage.

The above key assumptions have been made by Alpha to develop initial framework models for presentation and consideration by the Task Force. We envisage that the model selected by the Task Force, based on options from this report, for rollout of Personalised Budgets in Ireland, will be developed and enhanced based on the broader Workstream inputs and as the PB roll out process develops. In line with research findings of the NDA, it is expected that a PB system within the Irish context, may evolve over time in line with other jurisdictions past experiences.

3 Approach & Methodology

3.1 Approach Alpha has developed a set of methodologies, techniques and tools using industry best practice to enable effective, responsive project management and to ensure timely delivery of project outcomes. Alpha’s scope of work, as set out in the SRFT, in support of Workstream 5 of the Task Force is summarised in Figure 1 below. We followed a 5- stage cycle process shown in schematic form in Figure 2 below which sets out how we engaged with the Department and Task Force throughout the project, to develop the framework models presented in this report. Our approach to the development of Framework Model options is summarised in the schematic flowchart shown in Figure 2.

3.2 Project Governance At the Project Initiation meeting, Alpha reviewed their project approach with the Department, set out key project milestone deliverables and timelines, agreed the overall project plan and then tracked and reported progress against this plan on a regular basis. At the outset, Alpha agreed clear communication and reporting channels with the Department and fortnightly scheduled review meetings/conference calls were scheduled for Alpha and the Department to discuss progress and address project queries as they arose. As part of the project initiation, the Alpha team held meetings with the Workstream Task Force team leads and got a full debrief on the project and the other work being undertaken by the other Workstreams.


Figure 1: Alpha Scope of Work

During the project, the Alpha team held a workshop style meeting with the Task Force team leads and Department, at Hawkins House, to discuss progress on the development of Framework model options for PBs and to exchange ideas, information and get feedback on progress. Following the development of a number of draft framework model options and submission of preliminary draft report, Alpha held a workshop with the Task Force team members to engage in a Task Force team discussion and debate on these. This workshop helped provide clarity on approach and provided key information and guidance in the refinement of the framework models presented in this report. Alpha presented and discussed its draft report on administrative and governance models for personalised budgets with the Strategy Group, at their meeting on the 17th November 2017. Feedback from that meeting has been included in this final report.

3.3 Background Information & Detailed Research: The Department provided Alpha with a comprehensive briefing pack at the start of the project and exchanged relevant information from the other Workstreams to Alpha as the project developed. The Alpha team reviewed all the initial information and reports as provided which formed a foundation for our development work. Alpha’s development work then incorporated views and information from the Workstream teams as they became available. A full list of the Department’s reference documents is shown in Appendix 1. The research already undertaken by the NDA and their Synthesis Paper on personalised budgets (refer Appendix 1) was key input to Alpha’s work.


As part of Stage 2 in our methodology (Figure 2), Alpha conducted more extensive research to build on this database on personalised budgets or Independent Living as its referred to in some jurisdictions and to gather relevant additional learnings and experiences from other International jurisdictions.

Figure 2: Alpha Project Work Approach

At our initial meeting with members of the Strategy Group, Alpha discussed researching existing National schemes that could provide learning and guidance into the development of a suitable PB Governance and Administration system. Based on these discussions we selected and researched a total of thirteen National schemes and processes as follows:

1. Disability allowance 2. Blind welfare allowance 3. Student Universal Support Ireland (SUSI)


4. Disability Access Route to Education (DARE) 5. Fair Deal 6. Domiciliary Care Allowance (DCA) 7. Carers allowance 8. Carers Support Grant 9. Housing adaption grant for people with disability 10. Home help 11. Personal assistant support process 12. School Leavers support process 13. Medical card application

Alpha reviewed each of these schemes in detail based on publicly available information, reports provided by the Department and Alpha’s team experiences of the schemes/processes and created a summary document for each. The team then reviewed each scheme and discussed the ‘strengths’ and ‘weaknesses’ of each in the context of relevancy to a National Personalised Budget Administration and Governance system. This provided a solid information source and learning for the development of a suitable PB scheme. The Alpha team also researched a number of International Personalised Budget schemes. The International schemes reviewed were:

1. England 2. Scotland (referred to as ‘Self-Directed Support’) 3. Northern Ireland (referred to as ‘Self-Directed Support’) 4. The Netherlands

The information provided by the Department, Alpha’s detailed research on PBs, on National Schemes in Ireland and on International personalised budgets was synthesised and reviewed. This was then used as input and guidance into the preparation and development of framework model options for the administration and governance of personalised budgets in an Irish context.

3.4 Generic Framework Model Development The Alpha team initially worked on developing a very detailed ‘generic’ based PB model encompassing a wide range of model and pathway options to outline how a personalised budget might work in the Irish context. This generic model was further developed and expanded as a ‘discussion framework model’ and was used to engage with the Department and Task Force teams on a broad range of options and pathways enabling a comprehensive review and consideration of how a National PB scheme might work in Ireland. The Task Force and Alpha discussed several iterations of this generic model to address and include all potential parameters and matters under discussion and review by the other Workstream leads and to align with the overall brief and scope of work of the Task Force. The generic model set out 5 key stages for the application and governance of personalised budgets in an Irish context based on the assumptions list in Section 2, above. These 5 key stages are:

Stage 1: Information on Supports Options – the Person engages in an information and briefing stage to determine if a PB is likely to be desirable for them

Stage 2: Application – the person progresses to apply for a personalised budget and assessing Practitioner discusses an outline Personal Support Plan (PSP) and advises on availability of supports and funds for PB


Stage 3: Support & Planning – queries raised by the Person are addressed and payment options

discussed Stage 4: Implementation and Accountability – the Person decides on their preferred payment

model option for PB. The Person finalises their PSP, in consultation with Liaison Officer, Service Provider or Broker.

Stage 5: Review & Governance – Management of review and reporting mechanisms and ability to

amend PB where required This generic model was used to develop a number of framework model options which were:

• Model 1 – PB Application and Governance Prescriptive Option 1

• Model 2 – PB Application and Governance Prescriptive Option 2

• Model 3 – PB Application and Governance Alpha LEAN Model

• Model 4 – PB Application and Governance Light Touch Option 1

• Model 5 – PB Application and Governance Light Touch Option 2 During the development of these framework models, we had discussions with the Task Force on a possible ‘Future State’ on how PBs may integrate with existing current services. Whilst futuristic in its outlook, it sets out a possible future scenario as to how PBs and current services provided by HSE Disability services may develop. This future state is presented with the full model descriptions later in this report. Following presentation of these draft models and a Workshop facilitated by Alpha with the Workstream leads, these models have been refined and further developed. Based on the discussions from this Workshop Alpha has now refined the options into three framework models, as:



• Model 3 – PB Application and Governance Light Touch Approach Within each model there are multiple options and a number of different pathways the Person with a disability may follow, aligned with the key requirements set out in Section 1 above. These models, including detailed process maps, a description and SWOT analysis of each are presented later in this report.

3.5 Framework Model Assumptions The following key assumptions are incorporated into all framework model presented:

3.5.1 Person The ‘Person’ referred to throughout this process represents the person with a disability and/or his/her support network e.g. advocate or chosen representative. In certain circumstances a family member, advocate, guardian, decision-making assistant, co-decision-maker or decision-making representative may be nominated to act as fund manager and would assume the associated reporting and accountability responsibilities.


Throughout this document and the development and description of the proposed models, it is assumed that the Person is central to the discussions and decisions around their support needs. Where a Person has complex disabilities, or requires support to engage in any aspect of PB it is assumed that this support is available either through a family member or agreed advocate.

3.5.2 Support and Resource Administration Roles The support and resource administration roles throughout the process must be established and clearly defined. We will refer to ‘assessing practitioners’ and ‘liaison officers’ but these roles must be clearly defined in the context of existing roles and services and future personalised budget services. In many cases, a relationship will exist between HSE personnel and the Person and some will have detailed knowledge of the Person’s existing support needs and current services. We must consider how we can build on these current approaches for assessing the PB support needs of an individual whilst developing a seamless process that can evolve as PB develops. The PB system must also operate seamlessly in conjunction with the current HSE supported disability services. As the necessary infrastructure develops to support PBs, a potential desirable outcome may be that the ‘Assessing Practitioner’ and ‘Liaison Officer’ referred to throughout the models presented may be the same person but fulfilling both roles. This would have the advantage of a single point of contact for the Person throughout the process with all the advantages that would have for the Person, as well as likely efficiency gains from a HSE delivery perspective.

4 Governance in the Administration of Personalised Budgets This section considers Governance in a broad sense and sets out some recommended guiding principles aligned with the Vision and Mission of the Task Force for personalised budgets.

4.1 Overview The HSE Quality Assurance and Verification Division state that Governance for Quality Services involves having the necessary structures, processes, standards and oversight in place to ensure safe, person centred and effective services are delivered. Good governance1 sets standards of accountability, transparency, responsiveness, equity, empowerment and inclusiveness. Good governance should include the following:

• Empowerment of the Person with a disability

• The Person should be at the centre of decision making relating to their personal support plan

• Enhancement of quality of life for the Person

• Increase the capacity of the Person to self-determine

• Importance of shaping the Person’s own supports and services

• The Person to have ‘control and choice’

• Mechanisms to ensure balance of need, risk and civil liberties

• Identified agreed outcomes

1 HSE Quality Assurance & Verification Division – http://www.hse.ie/eng/about/QAVD

http://www.hse.ie/eng/about/QAVD


These guidelines refer to good governance by the Person getting the personalised budget. Detailed governance in regard to the funder and the management of funding is outlined in Stage 3 of Alpha’s proposed framework models – ‘Implementation and Accountability’ ensuring that there is no abuse of public monies. The governance guidelines adopted by Alpha draw on the existing HSE governance structures which we expect they will use in the roll out of personalised budgets for persons with disabilities.

4.2 Governance at each Stage of the PB Process As a general rule, the Person should be assisted and mentored in understanding their suitability for a PB and assisting them in reaching the most appropriate decision for them in relation to PBs and the “areas of personalised budget expenditure’ which are available under a PB. The Person should be fully supported in making their own decisions in relation to the supports and be at the heart of any process in relation to PBs. There should be assurance that the Person or their agreed advocate or chosen representative on their behalf, is leading the process by their full participation and collaboration in it and mechanisms put in place to ensure that this is happening at all stages. The following is the recommended underpinning governance process for all models:

4.2.1 Information on Supports Options & Application Stages Access to Personal Budgets should be straightforward to understand, easy to navigate and clear, easily accessible information in relation to the service available to the Person. This is likely to include, what the service is, the “areas of personalised budget expenditure”, how it can be accessed and what responsibilities are involved for the Person and the funder; what options are available to the Person in choosing who delivers the service, how the funds are managed and most importantly what are the agreed or aspired outcomes for the Person. The information supports would empower and enable the Person to be fully engaged in the process either through themselves or their advocates. Clear guidelines as to what the budget can be used for and by whom should be in place and easily accessible by all applicants. Standardised criteria for accessing a PB, whether the Person is known to the HSE Disability Services or not should be used ensuring equity of support. It is recommended that protocols in relation to communication to the Person or their chosen representative for the various outcomes be developed. There should be a clear process to support the Person who wants to avail of a PB and clarity on what PB support options are available to them at the time of applying for it. This would support the Person in making informed decisions as to whether PBs are for them or not or if a PB may be suitable for them in the future.

4.2.2 Support and Planning Stage This process should be person centred with the participation of the Person, giving them a voice in the decision making in relation to the supports required to meet their needs. The Person should be supported in making choices regarding the supports they wish to access and be given the opportunity to outline to the assessing practitioner the key elements which they believe will best meet their needs. There should be the opportunity for queries and any concerns which the Person may have in relation to the PBs being addressed at this stage. This approach is most likely to increase the ability of the Person to self-help. There should be a clear process around refining the Personal Support Plan (PSP) ensuring that the Person is central to the decision regarding the best payment options and provider of the support services to them. Protocols should allow for the Person to refuse the option of a PB at a point in time but in the knowledge, that they can reapply for a PB, if they so wish in the future.


There should also be protocols to guide the Person in relation to when a personalised budget is not available so that they can reapply should circumstances change. There should be clear and robust decision making with regards to how suitable a PB is for a Person and this clearly communicated to the Person. Examples of non-availability of a PB could be that the supports required by the Person are currently not available, that the Person indicates an unwillingness to adhere to governance requirements or indeed that the Person has wellbeing concerns regarding a PB.

A clear and transparent communication process should be in place from the funder to the Person in relation to what has been agreed and what is being funded. The Person should be supported to have a clear understanding of what the budget can be used for, what flexibility there is in using and spending the funding and the Person should understand where the funding can be used. The process should ensure the realisation of personal goals and the fulfilment of the Person’s aspirations. The funding should be for the direct benefit of the Person, not their care provider, support worker or family member. There needs to be good and clear protocols in relation to this to ensure good governance and ensuring that the Person should be fully informed of the controls which they have in relation to funding.

4.2.3 Implementation and Accountability & Review Stages A clear contract outlining the agreed funding which has been allocated to the Person and the agreed model for the use of the funding should be signed by both the funder and the Person. This should include the type of supports, the allocated funding or stated number of hours and how the agreed outcomes will be met. The Personal Support Plan will be finalised by the Person and their selected support groups – advocate/ Service Provider or Broker. There should be clear policies and processes in regards, to the payment of the funding and how it needs to be accounted for. Support should be available for the Person in assisting them to make the best decisions for them in relation to the model of service outlining the pros and cons of each option ensuring that they make the right decision for them and that this is based on informed choice. The process is likely to include the following:

• Reporting and accounting mechanisms regarding the funding

• The funder should ensure that the Person clearly understands the responsibilities that are attached to

the funding

• Training on “being an employer” ensuring that the Person understands the responsibilities of being an

employer including Payroll, Pensions, HR including Interviewing Skills, Process around Garda Vetting,

Workers Rights and Entitlements, Dispute and Conflict Resolution

• Training and Education needs of the support provider and how these needs are met by the Person.

• Understanding Quality Support

• Training for the Person in boundary Issues to ensure that they are not exploited

There should be the opportunity for the Person to raise queries and assurance that the Person is comfortable with all aspects of the funding and supports being offered. A contract should be signed by both parties, identifying how the agreed outcomes will be met and how the individual budget will be used. A process needs to be in place where a Person decides not to accept the offer of a personal budget and remain in the current disability support services to ensure that the Person is not disadvantaged in either


service delivery or funding. Furthermore, a process ensuring good governance is required where a Person may decide, after a period, to exit from the personalised budget in relation to re-entry into their previous supports. Protocols need to be developed regarding where the Person chooses and is approved for a mixed model of supports i.e. part of support funded through a personalised budget and other through the current HSE Disability Service funding. A clear outline of the review and monitoring processes and timelines for same should be outlined and agreed with the Person, including the option for the Person to request a review should there be a change in their circumstances or should their support needs change. In all models, the following governance risks should be considered:

• Balancing Risk enablement and the Duty of Care of the Funder to the Person

• Risk of Abuse of the Person

• Unregulated workers providing supports to Person

• Appropriate supports provision and outcomes as agreed in the person’s personal support plan

• Risk of budget “Run-away” where there is lack of monitoring of funds

• Safeguarding

• Persons being unsupported resulting in concerns or complaints not being addressed

4.2.4 Future State An adherence to agreed and recognised National Standards of Care2 in relation to personalised budgets should underpin all delivery models and options. In the ‘Future stage’ it is envisaged that an assessment of support needs will be carried out by an assessing practitioner using an agreed standardised assessment tool, identifying the support and care needs of the individual. From this assessment an outline personal support and care plan should emerge which should allow for the opportunity for the Person to consider a PB as an option to meet their support needs. Where a Person is already known to current services, their needs are identified, a support plan has been developed and they express a desire to move to a PB, then they should be assisted in making the choice as to whether a PB is the most suitable support service for them. The Person should be mentored in the same manner to gain an understanding of the suitability of a PB supports and what the process entails. There should also be the opportunity for both existing and new entrants to mix their support requirements i.e. a mix of current and PB service.

4.3 Appeals Process Where an application for a PB is refused or the Person is not happy with the allocated funding, a clear appeals process should be in place outlining how to appeal a decision and how decisions are made in relation to applications and assessments. There should be a time line around this process. All decisions regarding appeals should be communicated both in writing and in a meeting with the Person. There should be a facility for mediation ensuring a consensus orientated approach where disagreement arises between the funder and the Person. Alpha has set out recommended guidance for an appeals process in Section 8 of this report.

2 HIQA are in process of drawing up standards for Home Care which PBs may come under. This refers to a potential future state.


5 Framework Model Overview

5.1 Introduction The development of the final three framework models presented in this report was detailed in Section 3.4 above. There is considerable detail in the overall models developed and it was felt useful to present a summary comparison of the proposed models and associated governance structures. This section presents:

a) The potential ‘Future State’ of how a Personalised Budget system may work seamlessly and in parallel to the current HSE disability support services. This is useful to set out to show how, in the future a PB system may operate in an Irish context and it also demonstrates the potential of being extended to other service user cohorts or other Government funding streams in the future.

b) Framework model options comparison table c) Table showing comparison of potential governance structures for each framework model

5.2 Future State A map showing a potential ‘future state’ in shown in Figure 3 below. As PB evolves, it is envisaged that the Person will make the choice between PB and current services as an integral part of the their initial “assessment of support needs” and as their initial “personal support plan” (PSP) is developed. As illustrated, there are two potential groups of new persons who may become eligible for Disability support services, referred to as persons outside services and persons in services. The former group are persons with disabilities but who are not currently receiving support services and persons with acquired disabilities. The latter group represent all persons who are currently receiving or are eligible to receive Disability support services from the HSE – persons currently receiving disability support services and school leavers via the current school leavers process. These four groups of persons with disabilities are used throughout this report and referenced in all our model options. In this future model, there will be a clear assessment process including an agreed standardised assessment tool used to identify the support and care needs of the Person. This assessment process should be person-centred with the Person central to the process and involved in the discussions and decisions regarding their support plan. Once the assessment of support needs is completed the Person and assessing practitioner will agree the development of an outline personal support plan. The Person would be given an indicative budget after the initial assessment of support needs. This is likely to be a preliminary estimate only, which would be refined as the person progresses with the option of a PB and their personal support plan and corresponding funding are finalised at a later stage. The Person can then choose between entering current block support HSE services or opt for a personalised budget scheme or opt for a combination of both. Persons availing of current services should be able to move easily from these to PB to meet their changing needs. New entrants to the HSE Disability services will be given the choice of PB and /or current services as is appropriate to meet their needs at this initial assessment stage.

5.3 Framework Model Options – Comparison Table A comparison summary of the three framework models presented in this report is shown in Figure 4. This table highlights the differences between the 3 framework models:




• Model 3 – PB Application and Governance Light Touch Approach The first 3 stages of all models are the same with just some minor options included within the specific pathways.

5.4 Governance Summary Table A comparison summary table showing potential governance arrangements for each model is shown in Figure 5. In reviewing and setting out the governance for each model we took into consideration:

a) Proportionality – where governance and reporting requirements are linked with the level of funding provided to the Person

b) A ‘Phased Governance’ approach - where there are more stringent requirements to report on financials and evaluate the performance of the service provider or employee. This is to protect the Person with a disability and the funder during the initial stages of set-up and efficient running of a PB system.

c) In certain circumstances a family member, advocate, guardian, decision-making assistant, co-decision-maker or decision-making representative may be nominated to act as fund manager and may then assume the associated reporting and accountability responsibilities. The governance parameters, as set out for each model, would then become the responsibility of that person acting on behalf of the person.

5.5 Macro Overview Map of Personalised Budget Models A macro overview map of the potential ‘future state’ and proposed framework model option for PBs is shown in Figure 6. This shows how a Person may enter services in the future and following an assessment of support needs and approval of an indicative budget may then decide to go for a PB, current services or a mix of both.


Figure 3: Potential Future State for & Current Disability Support Services


Figure 4 Comparison Table of Framework Models for the Administration & Governance of PB


Figure 5 Governance Structures and Reporting Metrics


Figure 6 Overview Map of potential ‘Future State’ for PBs & Interaction of PB and Current Services


6 Framework Model Options for the Administration & Governance of PBs

6.1 Model 1 - PB Application & Governance Prescriptive Approach This model sets out a framework for the Administration and Governance of a National Personalised Budget scheme for Ireland. It was developed from Alpha’s generic framework model and whilst adhering to all the recommended outcomes for budget holders, it focuses on a high level of governance and involvement by the HSE throughout the process. A detailed process map has been developed for this Prescriptive model and this is shown in Appendix 2. A description of the 5 stages of this PB Framework model is given below taking each stage of the process in sequence.

6.1.1 Information on Supports Options Person will be provided with relevant information to determine if PB may be a desirable way to meet their support needs. This process may take a number of forms e.g. an online application system, telephone support line or face to face meetings. Whilst outside the scope of this work, information sources may include one, or all the following:

a) An information source where Person can make their own determination on whether PB is a desirable option.

b) Online interactive process and/or live chat system where Person will be guided -through a process of self-determination.

c) Telephone support line where Persons can discuss PB with a trained support officer, have any concerns or queries addressed and allow them to make an informed choice between PB and /or current services.

d) Face to Face meeting with a support officer or assessing practitioner, resulting in the person making an informed choice.

e) Briefing sessions

The outcome from this process will be the Person deciding to proceed with an application for a PB or to remain in current services. The Person will be able to review that decision at any time by availing of the above supports.

6.1.2 Application

Option 1: Once a Person is satisfied that PB is a desirable option for them, they will indicate this preference by submitting a PB application form. The application form may be completed online, available to download for completion, or request a form in the post, by email, phone, etc. It may require the Person to supply documentary evidence. We must consider how much detail in plans, outputs, outcomes, service providers etc. the Person will be required to provide at this stage and how much support the Person will require to reach a final decision on the suitability of a personalised budget to best meet their support needs.


Once submitted, the Person will receive a communication by letter, email, or text (subject to GDPR3 compliance), acknowledging receipt of the application, providing details of how the application status can be tracked online and outlining the timing for the application process. The application will be reviewed by an assessing practitioner. He/she may request more information, and this may be communicated by email, post, telephone call or text. It is important that the Person be placed at the centre of this process and communication will take the form of a two-way conversation that places the assessing practitioner in a support role. Option 2: Once a Person is satisfied that a PB may be desirable for them they can request a PB support assessment with the assessing practitioner. This will be a very personal service, where the Person’s support needs will be discussed and agreed together, and the Person will be supported through the application process and beyond. At this stage, whilst the Person’s support needs will have been assessed prior to entering the PB process, their needs may have changed, or they may choose to change the support services that are now available to them through PB. Equally the introduction of a PB option may completely alter the Person’s views on how they would like supports to be provided to them. The assessing practitioner will generate a summary of agreed supports required from their discussions with the Person. The process, from Option 1 or 2, will result in the Person and assessing practitioner agreeing that the Person:

a) may avail of a personalised budget

b) may remain with current services

c) may avail of part personalised budget and part current services.

In some cases, the support services requested may currently be unavailable through a personalised budget

and the Person will remain in current services. Where the Person decides to avail of PB, the assessing

practitioner will take one of the following actions:

a) Where funds required are below a given threshold, say € x, the assessing practitioner will make the

funds available

b) Where funds required are between a given range, say greater than € x but less than € y, the

assessing practitioner will seek approval for funds from their supervisor

c) Where funds required are above a given threshold, say € y, the assessing practitioner will seek

approval for funds from a supervising panel

6.1.3 PB Support Planning

The application process stage will result in one of the following decisions: a) Funds available for support services

b) Partial funds available for support services

c) Funds may be pending, subject to availability of supports

3 New General Data Protection Regulation (GDPR) due 25th March 2018


In each case the decision will be confirmed to the person. The ‘next steps’ to take to secure a Personalised Budget or the need to await availability of funds or PB supports will be clearly outlined to the Person. The Person will be given the option to accept the decision regarding their application for a personalised budget or to present further queries on their application. If the Person decides to refuse the PB, they will continue to receive their existing services. They will have an option to re-apply if circumstances change. They will also have the option of accepting a mix of some of the PB offered whilst retaining some of their existing HSE disability support services. If through the process the assessing practitioner and the Person fail to reach an agreement, then the Person will have the option to appeal. Once the PB is accepted, the Person and assessing practitioner will refine the personal support plan and discuss payment options. This description of the ‘PB Support Planning’ stage applies to all 3 Framework models presented.

6.1.4 Implementation and Accountability Once a decision has been made by the Person to take up a personalised budget the form of payment and governance of the associated funds must be agreed upon. We envisage the following fund management models:

1. Person managing fund

2. Fund paid directly to the service provider

3. Broker managed fund

4. Mix between options 1, 2 and 3.

6.1.4.1 Person Managed Fund - Payment Option 1 If the Person chooses to self-manage the funds, they may be entering into an employment contract with an employee or they may be entering a contractual agreement with a suitable service provider. They will need the skills to recruit and appoint employees and/or to invite and award contracts to service providers, to manage the funds, determine the outputs and outcomes required of the support services and to comply with the governance reporting requirements of the HSE. Mandatory HSE approved, training modules should be provided to all Persons in these areas. This may be one on one training, group classes, online interactive courses, or an online information source. Initial training may help inform the Person if a PB is still a desirable option to meet their personal support plan requirements and to provide them with choice and control of their life. The HSE will give the Person a list of approved service providers and they would advise the HSE of any employee options they were considering. Once the Person and the HSE Liaison Officer (LO) are happy to proceed, the Person will set up a suitable dedicated bank account or make agreed banking arrangements. The Person and LO will discuss potential service providers and/or employees and create a shortlist for further review or interview. The Person and LO will meet with service providers or interview potential employees and decide on preferred option. The rules around appointing service providers will have to be determined. There will be rules regarding costs,


qualifications, relationship to the Person and standards to meet etc. Terms and conditions will be finalised, and contracts developed. The service provider or employee will sign the contract with the Person. A clear reporting structure will be put in place and regular PB reviews will be scheduled and carried out by the Person with involvement of the HSE. This process should include the Person monitoring and reporting on performance of the service provider and on expenditure. It will measure outcomes achieved against planned targets. Governance arrangements for the PB between the Person, the provider and the HSE will be agreed as part of the contractual arrangements. As set out in Section 3.5.1 above, in certain circumstances a family member, advocate, guardian, decision-making assistant, co-decision-maker or decision-making representative may be nominated to act as fund manager and they would assume the associated reporting and accountability responsibilities for the PB fund on behalf of the Person.

6.1.4.2 Budget Paid Directly to Service Provider – Payment Option 2

In the case where it is agreed that the funding will be paid directly to a service provider, the contract for services will be between the HSE and the service provider but with the Person determining and agreeing the support services and selecting the service provider with the HSE. It will suit the Person who wants a direct relationship with the service provider but not the responsibilities of being an employer and/or entering a contractual relationship with the service provider. The Person will undergo mandatory training of appropriate HSE approved training modules. The Person will be provided with a list of approved service providers by the HSE, will review this list and select a preferred service provider. Terms and conditions will be agreed by the Person and the service provider with input from the HSE. Once the terms and conditions are finalised a contract will be issued and signed by the HSE, Person and service provider. A clear reporting structure will be put in place and regular PB reviews will be scheduled and carried out by the Person with involvement of the HSE. This process should include the Person monitoring and regularly reporting on the performance of the service provider to the HSE. It will measure outcomes achieved against planned targets. The HSE will monitor the service provider. Governance arrangements for the PB between the Person, the service provider and the HSE will be agreed as part of the contractual arrangements.

6.1.4.3 Broker Managed Fund The Person will undergo mandatory training of appropriate HSE approved training modules. This will equip the Person with the skillsets necessary to engage the appropriate services of a suitably qualified brokerage company. The Person will receive a list of HSE approved brokers and will review and engage in discussions with them to determine which of the following broker options best meets their needs:

a) Broker as the employer b) Broker as facilitator c) Broker as financial intermediary /manager

The Person will select their preferred Broker and Broker option and will agree the terms and conditions with them.


Option A) Broker as the Employer

The Broker will manage the whole process from helping to finalise the personal support plan, sourcing suitable providers/employees, agreeing terms and conditions, appointing the providers/employees, monitoring the performance of the provider and reporting to the HSE. The broker will directly employ the service provider/employee and take on all responsibility for sick cover, holiday cover etc. The broker will be responsible for reporting financials to the HSE and the Person in consultation with the broker will report on the performance of the service provider/employee. Option B) Broker as Facilitator In this model, the Broker will support the Person in finalising their personal support plan, sourcing suitable providers/employees, agreeing terms and conditions and appointing the service providers/employees. In this model, the Person may decide to use the broker as a once off service to facilitate and advise on setting up a personalised budget or they may keep on the broker as an advisor to help them with the running and monitoring of their PB. Option C) Broker as Financial Intermediary / Manager In this model, the Person may decide to engage the Broker to manage the finances on their behalf or to provide management services to the Person. The Person would agree the specific role of the Broker and agree a contract with them. The Person/Broker will report to the HSE on the financials and performance of the service providers or employees. In all cases, the Person will be required to set up a dedicated bank account and/or make suitable banking arrangements. Payments will be made directly to the Person who will in turn pay the broker for their services, as appropriate.

6.1.4.4 Mix between options 1, 2 and 3

It is possible that the Person will access PB through more than one fund management model where they

require multiple support services. A Person may choose, for example, to employ one service provider

directly, another through a broker and/ or opt to have another service provider paid directly by the HSE.

The set-up, monitoring and reporting in each case will be appropriate to the fund management.

It is expected, that the offer to have multiple fund arrangements may evolve over time as the initial PB

scheme is rolled-out and as the process moves to a potential ‘future state’ as presented earlier. The earlier

phases of PB may initially allow just one funding scheme to allow for the development of suitably efficient

governance systems and reporting criteria.


6.1.5 Review of Personalised Budget A review will be carried out by the assessing practitioner (or Liaison Officer) at agreed scheduled intervals or at the request of the Person. The Person, service provider and broker, where used, will provide evidence and commentary on the level of supports and required financial reports to the HSE. These reports will be collected and reviewed by the assessing practitioner and one of the following recommended

a) the existing funding/services being approved for another agreed period

b) Personal support plan, discussed and amendments recommended. If the amendments are

agreed and actioned, a new contract will be agreed between the Person, the service provider,

broker and HSE as appropriate.

c) If the amendments are not agreed, the Person may continue with PB based on partial

supports and mix with or re-enter previous or current HSE block services. The Person may

appeal this.

d) Insufficient funding for next period – here the Person may continue with PB based on partial

supports and mix with or re-enter previous or other current HSE block services. They will have

the option to appeal.

Protocols will be developed from the outset setting out how the review process will be carried out and

how the Person will be central to these reviews. These should set out the conditions under which

amendments may be recommended to the Person’s personal support plan and/ or where insufficient

funding is available for renewal of the PB support services.

6.1.6 Strengths & Weaknesses Analysis A SWOT analysis has been developed for this proposed Prescriptive Model as shown below. Information on Supports Options (for All Models) Strengths:

• All Persons with disabilities can gain access to a PB support service through a mix of information sources

• By having the option to complete a reckoner online, over the phone or through self-assessment via an information sheet it is possible for the Person to have an idea if PB will suit them before formally entering any type of application process. This could potentially eliminate any fear of wasting time, or fear of having services interrupted by making enquiries as to what other options may be available.

• The provision of a number of different information options ensures that Persons having complex disabilities or those with less complex needs may equally and independently determine if PB is a suitable option for them.

• The option for continuous reviewing and re-entering the application stage ensures that all Persons at any stage can recommence their application to take up a PB giving choice and control. Weaknesses:

• The cost involved with providing multiple information mediums to the Person could undermine the financial viability of the service.


Application (for All Models) Strengths

• By offering a standard application form it would be easy to process applications.

• A ‘tick box exercise’ would make it very clear for a Person to determine if PB may be suitable for them

• The financial cost of processing an initial application would be more cost effective than a face to face assessment.

Weaknesses

• This system based application process reduces the direct interface with assessing practitioner for the Person

• It reduces the personal assessment of PB needs in the context of the person and their environment.

Support Planning Stage (for All Models) Strengths:

• It allows the Person the opportunity at any point to refuse the PB option and remain in the current services being offered.

• It allows the opportunity for any queries or issues that the Person may have to be communicated to the assessing practitioner and discussed in enough detail as is necessary for the Person to come to a decision that they are happy with.

• It is at this stage that the Person’s personal support plan will be refined, and the Person will be able to make an informed decision based on their support needs on which payment option may best suit them.

Weaknesses:

• The option of a continuous loop of queries and answers could add a significant delay in the process of finalising an application.

• Allowing the option for the Person to reapply at any point after their suitability for a PB has been declined could be a challenge to resources and set unrealistic expectations.

Implementation & Accountability Option 1: Direct Payment Strengths:

• Attending mandatory approved training courses and requesting proof of training will ensure that all Persons are suitably qualified, informed and capable of managing their own PB

• Having a list of approved service providers will ensure high quality services. This will also save time for the Person and make the process more user friendly.

• Having the Person monitor the service provider by reporting and carrying out agreed regular performance reviews will ensure that the Person is happy with the supports they are receiving.

• Having the HSE involved in the regular performance reviews will ensure that the support service is delivered to agreed standards and efficiency levels.

Weaknesses:

• Providing training courses to a suitably high standard will have resource implications.


Option 2: Budget Paid Directly to Service Provider Strengths:

• This option allows the Person to benefit from PB but not have the responsibilities and pressures of becoming an employer


• Person has flexibility Weakness:

• Availability of service providers may cause waiting times.

• The Person potentially loses out on the potential of a single employee option

Option 3: Broker Managed Fund Strengths:

• Allows the Person the opportunity of having a PB without having the pressure of managing their own employees.

• Person has flexibility – by having option for broker as an employer, facilitator or Manager allows the Person to decide how much control they want.

Weaknesses:

• May have administration costs that must come out of the Person’s PB

• Lack of availability of regulated brokers

6.2 Model 2 – PB Application and Governance Alpha LEAN Approach

This model sets out a framework for the Administration and Governance of a National Personalised Budget scheme for Ireland. It sets out a balanced approach with an appropriate but not overly burdensome level of governance. It gives control and choice to the person whilst adopting a LEAN approach to HSE involvement to maintain standards and ensure value for money service delivery. A detailed process map has been developed for this Alpha LEAN model option and this is shown in Appendix 3. A description of the 5 stages of this PB Framework model is given below taking each stage of the process in sequence.

6.2.1 Information on Supports Options As for Model 1

6.2.2 Application

As for Model 1



As for Model 1

6.2.4 Implementation and Accountability Once a decision has been made by the Person to take up a personalised budget the form or payment and governance of the associated funds must be agreed upon. We envisage the following fund management models:





6.2.4.1 Person Managed Fund - Payment Option 1 If the Person chooses to self-manage the funds, they may be entering into an employment contract with an employee or they may be entering a contractual agreement with a suitable service provider. They will need the skills to recruit and appoint employees and/or to invite and award contracts to service providers, to manage the funds, determine the outputs and outcomes required of the support services and to comply with the governance reporting requirements of the HSE. Mandatory HSE approved, training modules should be provided to all Persons in these areas. This may be one on one training, group classes, online interactive courses, or an online information source. Initial training may help inform the Person if a PB is still a desirable option to meet their personal support plan requirements and to provide them with choice and control of their life. It will be mandatory for the Person to attend training or if they feel they already have some of the skills required, they will be required to provide evidence of previous training completed. The Person could also opt to select other training providers rather than using the HSE training modules. Once the assessing practitioner and the Person are happy to proceed, the Person will set up a suitable dedicated bank account or make agreed banking arrangements. HSE will provide a list of approved service providers. The Person will review the list and will have the choice of adding additional service providers or potential employees for them to consider. The Person will review the terms and conditions associated with the options they are considering and will choose their preferred option – employee or service provider. The Person will be responsible for the full management of the funds allocated and for paying the service provider or employee and keeping appropriate financial records. A clear reporting structure will be put in place and regular agreed reviews of the performance of the service provider or employee will be conducted by the Person and reported to the HSE. This Person will be responsible for this ongoing monitoring and reporting of financials and level of supports received.


In the case where it is agreed that the funding will be paid directly to a service provider, the contract for services will be between the HSE and the service provider but with the Person determining and agreeing


the services and selecting the service provider with the HSE. It will suit the Person who wants a direct relationship with the service provider but not the responsibilities of being an employer and/or entering a contractual relationship with the service provider. The Person will undergo mandatory training of appropriate HSE approved training modules. The Person will be provided with a list of approved service providers by the HSE and may add additional service providers of their choice. They will review and select a preferred service provider. Terms and conditions will be agreed by the Person and the service provider with input from the HSE. Once the terms and conditions are finalised a contract will be issued and signed by the HSE, Person and service provider. A clear reporting structure will be put in place and regular PB reviews will be scheduled and carried out by the Person with involvement of the HSE. This process should include the Person monitoring and regularly reporting on performance of the service provider to the HSE. It will measure outcomes achieved against planned targets. The HSE will monitor the service provider. Governance arrangements for the PB between the Person, the service provider and the HSE will be agreed as part of the contractual arrangements.


d) Broker as the employer e) Broker as facilitator f) Broker as financial intermediary /manager

The Person will select their preferred Broker and Broker option and will agree the terms and conditions with them. Option A) Broker as the Employer

The Broker will manage the whole process from helping to finalise the personal support plan, sourcing suitable providers/employees, agreeing terms and conditions, appointing the providers/employees, monitoring the performance of the provider and reporting to the HSE. The broker will directly employ the service provider/employee and take on all responsibility for sick cover, holiday cover etc. The broker will be responsible for reporting financials to the HSE and the Person in consultation with the broker will report on the performance of the service provider/employee. Option B) Broker as Facilitator In this model, the Broker will support the Person in finalising their personal support plan, sourcing suitable providers, agreeing terms and conditions and appointing the service providers/employees. The Person may decide to use the broker as a once off service to facilitate and advise on setting up a personalised budget or they may keep on the broker as an advisor to help them with the running and monitoring of their PB.


Option C) Broker as Financial Intermediary / Manager In this model, the Person may decide to engage the Broker to manage the finances on their behalf or to provide ongoing management services to the Person. The Person would agree the specific role of the Broker and agree a contract with them. The Person/Broker will report to the HSE on the financials and performance of the service providers or employees. In all cases, the Person will be required to set up a dedicated bank account and/or make suitable banking arrangements. Payments will be made directly to the Person who will in turn pay the broker for their services, as appropriate.


It is possible, that the Person will access PB through more than one fund management model where they


directly, another through a broker and or opt to have another service provider paid directly by the HSE. The

set-up, monitoring and reporting in each case will be appropriate to the fund management.





6.2.5 Review of Personalised Budget As for Model 1.

6.2.6 Strengths & Weaknesses Analysis A SWOT analysis has been developed for this proposed Streamline Model as shown below. Implementation & Accountability Option 1: Direct Payment Strengths:

• Offering approved training courses and requesting proof of previous training will ensure that all Persons are suitably qualified, informed, and capable of managing their own PB


• Having the Person monitor the service provider by reporting and carrying out agreed regular performance reviews will ensure that the Person is happy with the supports they are receiving and that standards are maintained.


• Having agreed regular and appropriate reviews with the HSE will contribute to good governance, maintenance of quality of standards and meet with the requirements of appropriate monitoring of public funds.

Weaknesses:

• Providing training courses at a suitably high standard will have resource implications. Option 2: Budget Paid Directly to Service Provider Strengths:

•



• Person has flexibility and control of the process Weakness:




• This option allows the Person to benefit from PB but not have the pressure of becoming an employer and dealing with the financial aspects of PB (where broker acts as employer).

• Person has flexibility – by having option for broker as an employer, facilitator or Manager, it allows the person to decide how much control they have.

• Broker option gives the Person the opportunity to change the administration of their PB if their needs or circumstances changes

Weaknesses:

• May have administration costs that must come out of the Persons PB


6.3 Model 3 – PB Application and Governance Light Touch Approach

This model sets out a framework for the Administration and Governance of a National Personalised Budget scheme for Ireland. It was developed from Alpha’s generic framework model and whilst adhering to all the recommended outcomes for budget holders, it focuses on a low level of governance and involvement by the HSE throughout the process. It promotes a higher level of autonomy, control and choice for the Person. A detailed process map has been developed for this Light-touch Model and is shown in Appendix 4. A description of the 5 stages of this PB Framework model is given below taking each stage of the process in sequence.


6.3.1 Information on Supports Options As for Model 1

6.3.2 Application

As for Model 1


As for Model 1

6.3.4 Implementation and Accountability Once a decision has been made by the Person to take up a personalised budget the form or payment and governance of the associated funds must be agreed upon. We envisage the following fund management models:





6.3.4.1 Person Managed Fund - Payment Option 1 If the Person chooses to self-manage the funds, they may be entering into an employment contract with an employee or they may be entering a contractual relationship with a suitable service provider. They will need the skills to recruit and appoint employees and/or to invite and award contracts to service providers, to manage the funds, determine the outputs and outcomes required of the support services and to comply with the governance reporting requirements of the HSE. Training modules will be provided to all Persons in these areas. This may be one on one training, group classes, online interactive courses, or an online information source. Initial training may help inform the Person if PB is a desirable option to meet their personal support needs. Persons will be required to attend training or if they feel they already have some of the skills required, they will be required to provide evidence of previous training completed. Once the assessing practitioner and the Person are happy to proceed, the Person will set up a suitable dedicated bank account or make agreed banking arrangements. HSE will provide a list of approved service providers. The Person will review the list and will have the choice of adding additional service providers or potential employees for them to consider. The Person will review the terms and conditions associated with the options they are considering and will choose their preferred option – employee or service provider. The Person will review the terms and conditions for the employee or service provider and will select their preferred provider or employee. This may require an interview process. Once selected, the Person will finalise terms and conditions with the service provider and contracts will be signed. The Person will have complete autonomy in reviewing and agreeing terms and conditions with the service provider or employee.


The Person will be responsible for the full management of the funds allocated and for paying the service provider or employee and keeping appropriate financial records. A clear reporting structure will be put in place and regular agreed reviews of the performance of the service provider or employee will be conducted by the Person and reported to the HSE. This Person will be responsible for this ongoing monitoring and reporting of financials and level of supports received.


In the case, where it is agreed that the funding will be paid directly to a service provider, the contract for services will be between the HSE and the service provider but with the Person determining and agreeing the services and selecting the service provider with the HSE. It will suit the Person who wants a direct relationship with the service provider but not the responsibilities of being an employer and/or entering a contractual relationship with the service provider. The Person will undergo mandatory training of appropriate HSE approved training modules. The Person will be provided with a list of approved service providers by the HSE and may add additional service providers of their choice. They will review and select a preferred service provider. Terms and conditions will be agreed by the Person and the service provider with input from the HSE. Once the terms and conditions are finalised a contract will be issued and signed by the HSE, Person and service provider. A clear reporting structure will be put in place and regular PB reviews will be scheduled and carried out by the Person with involvement of the HSE. This process should include the Person monitoring and regularly reporting on performance of the service provider to the HSE. It will measure outcomes achieved against planned targets. The HSE will monitor the service provider. Governance arrangements for the PB between the Person, the service provider and the HSE will be agreed as part of the contractual arrangements.


g) Broker as the employer h) Broker as facilitator i) Broker as financial intermediary /manager

The Person will select their preferred Broker and Broker option and will agree the terms and conditions with them. Option A) Broker as the Employer

The Broker will manage the whole process from helping to finalise the personal support plan, sourcing suitable providers/employees, agreeing terms and conditions, appointing the providers/employees, monitoring the performance of the provider and reporting to the HSE. The broker will directly employ the service provider/employee and take on all responsibility for sick cover, holiday cover etc. The broker will


be responsible for reporting financials to the HSE and the Person in consultation with the broker will report on the performance of the service provider/employee. Option B) Broker as Facilitator In this model, the Broker will support the Person in finalising their personal support plan, sourcing suitable providers, agreeing terms and conditions and appointing the service providers/employees. The Person may decide to use the broker as a once off service to facilitate and advise on setting up a personalised budget or they may keep on the broker as an advisor to help them with the running and monitoring of their PB. Option C) Broker as Financial Intermediary / Manager In this model, the Person may decide to engage the Broker to manage the finances on their behalf or to provide management services to the Person. The Person would agree the specific role of the Broker and agree a contract with them. The Person/Broker will report to the HSE on the financials and performance of the service providers or employees. In all cases, the Person will be required to set up a dedicated bank account and/or make suitable banking arrangements. Payments will be made directly to the Person who will in turn pay the broker for their services, as appropriate.


It is possible that the Person will access PB through more than one fund management model where they


directly, another through a broker and or opt to have another service provider paid directly by the HSE. The

set-up, monitoring and reporting in each case will be appropriate to the fund management.





6.3.5 Review of Personalised Budget As for Model 1.

6.3.6 Strengths & Weaknesses Analysis A SWOT analysis has been developed for this proposed Light Touch Model as shown below.


Implementation & Accountability Option 1: Direct Payment Strengths:

• Offering approved training courses and requesting proof of previous training will ensure that all persons are suitably qualified, informed, and capable of managing their own PB


• Having the Person monitor the service provider by reporting and carrying out agreed regular performance reviews will ensure that the person is happy with the supports they are receiving and that standards are maintained.

• Having agreed regular and appropriate reviews with the HSE will contribute to good governance, maintenance of quality of standards and meet with the requirements of appropriate monitoring of public funds.

Weaknesses:

• Providing training courses at a suitably high standard will have resource implications. Option 2: Budget Paid Directly to Service Provider Strengths:

•



• Person has flexibility and control of the process Weakness:




• This option allows the Person to benefit from PB but not have the pressure of handling becoming an employer and dealing with the financial aspects of PB (where broker acts as employer).

• Person has flexibility – by having option for broker as an employer, facilitator or Manager, it allows the person to decide how much control they have.

• Broker option gives the Person the opportunity to change the administration of their PB if their needs or circumstances changes

Weaknesses:

• May have administration costs that must come out of the Persons PB



6.4 Assessing Practitioner and Liaison Officer Roles The Assessing Practitioner and Liaison Officer can be one in the same person, but they have two distinct roles regarding their relationship with the Person who wishes to have a personalised budget for managing their supports. The main role of the Assessing Practitioner is, in collaboration with the Person, to assess their support needs, to give information and guidance to the Person to enable them to make an informed decision on whether a personal budget is suitable for them and if so which is the right option/ model for them. The assessing practitioner may, as part of the assessment help to identify the person’s preferences, needs etc. This may include deciding with the Person, how much control he/she wishes to have over how their supports are delivered. The assessing practitioner may also guide the Person regarding the risks and challenges of managing a PB. The assessing practitioner may also draw up/write an agreed personal support plan, estimate the cost of this and confirm the availability of the PB supports to the Person. The role of the Liaison Officer continues to be one of collaboration and advice to the Person, working with him/her in supporting the implementation of the Person’s personal support plan which may involve providing advice to the person in reviewing the potential service providers/ employees, selection process with the Person. The liaison officer may also support the Person in the identification of a suitable broker where the Person decides to use this model. The liaison officer is there to ensure that the support needs of the Person as agreed in the personal support plan are being met and delivered as the Person wishes. They are also available to ensure that any changes which the Person identifies are reassessed and implemented within available resources. They also consider any change of circumstances which may occur in the life of the Person, triggering an updated assessment of support needs. The liaison officer will be involved in performance reviewing of the PB with the Person and in ensuring that the service providers, employees and/or broker delivers the supports to the Person to the expected quality standards and governance compliance requirements.

7 Opportunities & Threats for Personalised Budgets Information on Supports Options Opportunities

• To develop a LEAN access process that can be developed across multiple public services, reducing

resources required in the processing of applications of many public services.

• To improve the service interface for all Persons, including those with complex disabilities, across

multiple public services.

• To road test access for complex disabilities which may be applied to all services.

Threats

• Sufficient funding not being made available to put the required systems in place to manage an

interactive, user led process.

• The un-bundling of current services may initially take time limiting potential funding for PBs


Application Opportunities

• To develop an application process that is person focused and user led, including those of complex

disabilities and may be developed as a ‘best in class’ that can be applied across all public services.

• Developing an application process for a potential ‘future state’ that may include PB as an option to

accessing disability services offers the potential opportunity to review and improve access across all

disability services.

Threats

• The pace of changing technology and its use by Persons with disabilities may make it a challenge to

maintain an application process that is ‘best in class’ within budget.

Support Planning Stage Opportunities

• Developing personal support plans for Persons would be expected to give an excellent insight

into the services required to meet current and future needs of Persons with disabilities. This

may help prioritise service delivery across all disability services.

Threats

• Shortage in service providers may result in some Persons being unable to access services through PB.

This may result in a public perception that PB does not work.

Implementation & Accountability Opportunities

• Allowing Persons to nominate potential service providers or employees that are not previously

approved by the HSE, may give the opportunity to expand the base of service providers which could

benefit all Persons

• Providing training to Persons is likely to result in a cohort of Persons who are proficient and

experienced in managing their funds, giving an opportunity to guide and mentor future users.

• Possible future efficiencies resulting from groups of Persons joining together to purchase services.

• Empowering Persons to shape the disability service provider market by demanding a more targeted

support services for their needs. Fitting the service providers services to meet Person’s needs rather

than the Person having to adjust to the services provided.

• Developing the brokerage system is likely to introduce a new professional body to the service

provider market in Ireland

Threats

• Funding restrictions may limit the ‘areas of personalised budget expenditure’ available through PB and

may result in Persons losing faith in the PB

• Shortage of service providers may limit the effectiveness of PB

• Shortage of training skills/providers may delay Persons entering into PB


• Lack of oversight of the broker due to inexperience of the model may lead to inefficiencies.

• Safeguarding of the Person and the available funds to them for a PB

• Proliferation of unregulated service providers or brokers

• Lack of adequate governance and performance monitoring leading to poor quality supports to the

Persons and inappropriate use of PB funds.

8 Appeals Process The HSE Quality Assurance and Verification Division state that the purpose of the HSE Appeals Service4 is to

provide internal, independent and impartial review of decisions taken by personnel of the HSE relating to

applications by members of the public for specified service and entitlements where applicants are

dissatisfied with the outcome of their application.

The function of the Appeals Services is to demonstrably and transparently provide fair and equitable

treatment of all members of the general public who wish to have decisions made by HSE personnel

reviewed.

The Appeals Service provides a facility for an independent review of decisions on applications for HSE

schemes and services. It supports the appellants' rights to privacy, impartiality, respect and sensitivity in the

way appeals are processed, having due regards to appellants' age, ability to communicate, mobility and

capacity to understand complex legislation, regulations and procedures.

Taking the above into consideration, the following process may be used in relation to PB services where a

Person wishes to appeal a decision in relation to the PB service.

Verbal Appeal

• Verbal appeals may initially go to the Assessing Practitioner or Liaison Officer

• Where there is a verbal appeal it should be responded to within 24 hours

• Efforts should be sought to resolve the matter informally through discussion and consensus resulting in

agreement of the proposed resolution

• Where no resolution is found then the matter should be escalated to the next stage i.e. appointment of

an Appeals Officer

Written Appeals

• Written appeals should be acknowledged within 5 working days

• An Appeals Officer should be appointed

• Appointed Appeals Officer writes to the Person outlining the reasons the Person’s appeal is being

examined giving a time line of 21 days for an outcome

• Appeals Officer gathers evidence and talks to all parties including the Assessing Practitioner, Liaison

Officer and Person or their Advocate

• Appeals Officer should endeavour to resolve the matter informally if possible

• Where no resolution is reached than the Appeals Officer should initiate a formal investigation

4 HSE Quality Assurance and Verification Division – Appeals Service – http://www.hse.ie/eng/about/QAVD/Appeals-Service/

http://www.hse.ie/eng/about/QAVD/Appeals-Service/


• Person should be communicated with, explaining that a formal investigation has been initiated and a

decision in writing will be communicated to the Person within 30 days

• Appeals Officer will consider all information and prepare a final report.

• Final Report will outline grounds for appeal detailing all information including reasoning for the decision

/refusal and recommendations including whether the original decision is upheld, or appeal is upheld

The parameters and timelines around the appeals process are important and we recommend these be discussed and clear guidelines agreed on response times, communication etc applicable to PB.

9 Training of Persons Applying for a Personalised Budget Whilst opting to directly employ personal assistants as part of Personal Budgets is positive and empowering and gives maximum flexibility to tailor to individual support lifestyle and needs, it also brings responsibilities from a legal, HR and financial perspective. Training of Persons with disabilities may include the following modules and cover these topics: Becoming an Employer:

• Basic Employment Law including the responsibilities of being employer and safe recruitment and

employment processes

• Drawing up a job description

• Setting out the Tasks

• Adverting the post

• Selection Process

• Interview Process and skills training

• Choosing the right person

• Doing the checks including references and Garda vetting

• Contract of Employment how to draw up same

• Health and Safety Training

• Arranging staff induction and training

• Agreeing a probation period

• Getting public liability and employer’s insurance

• Getting employer’s indemnity insurance

• Data Protection

Managing Money and HR Responsibilities:

• Payroll and related topics

• How to set up a separate bank account

• How to manage salaries for employees

• Understanding matters in relation to Statutory Leave and payments for same this should include

Sick Pay, Holiday Pay etc.

• Understanding responsibility for National Insurance and Pensions

Performance Management:

• Understanding how to ensure that support needs are meeting the agreed outcomes as identified

in the personal support plan

• Conflict Resolution


• Rosters

• Ensuring tasks are being performed as agreed and laid out in the job description

• Supervision of staff

• Understanding of Grievance and Disciplinary Procedures

Reporting Requirements:

• How to keep an employee record and report on same

• Time sheets

• Reporting on budget spend to funder

• Reporting agreed outcomes

10 Financial Sustainability We developed a comparison table of cost elements associated with the set up, implementation and on-going monitoring and governance of PBs for the three models presented and this is shown in Figure 7 below. This aims to set out the likely cost elements associated with each phase and each stage of the administration and governance of PBs for the three models. We envisage that this table will facilitate the preparation of actual costings for each model. The table shows, insofar as is possible at this point, the relative costs of each framework model and the potential relative recurring costs for the on-going administration and governance of each.


Figure 7: Financial Summary Table showing comparison of relative costs for each Model


Appendix 1: Documents Provided by Department used as input to the Development of Framework Model Options


Appendix 2: Model 1 – PB Application and Governance Prescriptive Approach

Model 1 -

Prescriptive Model -v7.pdf

Appendix 3: Model 2 – PB Application and Governance Alpha LEAN Approach

Model 2 - Alpha

LEAN Model -v7.pdf

Appendix 4: Model 3 – PB Application and Governance Light Touch Approach

Model 3 - Lightouch

Model -v7.pdf