Personalised SupportPersonal Budgets & Flexible Support

1. History

2. Innovations

3. Impact

4. Challenge

5. Opportunity

History

• The best way to think about personalised support is not by starting with government policy.

• This is an ethical issue, which has been driven forward by radical grassroots action.

• 50 years ago disabled people started demanding the right to be citizens.

• Two generations of battle to close institutions and develop personalised forms of support instead.

• Today there is still much to do…

Combine with lobbying for political and legal changes activist have created practical alternatives. For people with learning disabilities some of the most important include:

1. Individual service design, planning and policies

2. Managed personal assistants and shared management

3. Individualised funding (e.g. Individual Service Funds)

4. Supported decision-making and family leadership

5. Access to ordinary housing

6. Quality checking by people and families

Innovations

Recent survey of 156 providers of personalised support helps reveal some of the key elements involved in providing personalised support.

WHAT IS…? NOT…

Individual design slotting people into a placement

Creative planning another ?@*&^ person-centred plan

People/families make decisions it’s the organisation’s way or the highway

Quality checking professional knows best

Matching staff to people generic support roles

Individualised policies organisational health & safety rules

Full housing options we’ve got a lovely group home for you

People/families recruit staff staffing is our business

Individual budget protected money is a mystery

Direct management possible their our staff, not yours

Not all personalised support providers were using Individual Service Funds (ISFs) yet. However the organisations that had been using ISFs the longest are most likely to be doing all the key elements of personalised support.

Why does individualised funding help?

• Focus - The solution to one person’s needs doesn’t get muddled up with others

• Creativity - You can create solutions around that person’s community and dreams

• Trust - Everyone believes that the person’s budget is safe and changes benefit them

Impact

Inclusion Glasgow worked with people with complex disabilities, moving from institutions to individually designed support solutions in the community.

Research on the work of Inclusion Glasgow demonstrated high levels of efficiency, improvements in people’s lives and lower costs over time. There was a 46% reduction in hours of support over a 5 years period.

Choice Support converted a block contract for 83 people into 83 personal budgets - managed by the organisation - ie. Individual Service Funds (ISFs).

This work was associated with reduced costs and improved lives.

Like many service providers, Choice Support were happy to accept short termination periods on that contracts - and the ability of people to end those contracts - instead of risky block contracts subject to tendering and procurement.

Choice Support converted a large block contract into 83 individualised services, with a saving of 28% over 3 years.

Social workers and support staff came to see the process as personally rewarding.

• Today Glasgow Council are threatening to put Margaret in a care home because her package of support is too high.

• Her carers and independent citizens are being denied the right to advocate for Margaret.

Challenge

• Austerity and cuts to social care

• On-going institutionalisation

• Procurement and tendering practices

• Lobbying by residential care industry

• Fragmented advocacy movement

• In a 3 month period 25.9% of inpatients had harmed themselves • 21.0% of inpatients had suffered an accident in the last 3

months • 22.2% of people had suffered physical assault in the last 3

months • Physical restraint had been used 34.2% of people in the last 3

months 11.4% had suffered seclusion in the last 3 months • 56.6% of people had been the subject of at least one incident

involving self harm, an accident, physical assault against them, hands-on restraint or seclusion during the last three months

• Antipsychotic medication used regularly or at least once in the last 28 days for 68.3% of the people in the units

…confused responsibility & liability

We still spend most of out social care funding on residential care (but that is now dropping)

• Many charities unwilling or unable to campaign

• Different disability groups competing

• Government threatening behaviour (e.g. lobbying act and other restrictions on free speech)

• Confusion about what kind of system people want to defend (e.g. residential care vs. inclusion)

• System confusion (e.g. children vs adults; health vs social care)

• Public and media ignorance

Opportunity

• Some commissioners, like Dorset, see there’s a better way

• Care Act 2014 and NHS personalisation supports the change

• Limited funding can be used more effectively with creativity and focus on community connections

• There is effective on-going pressure around ATUs etc.

• Many providers want to break out of long-term block of framework contracts and be accountable to people.

Recent work in Calderdale has led to the use of ISFs becoming the main way that home care is provided. Over time this is encouraging more innovative and flexible support from service providers.

MOST IMPORTANTLY - to provide creative and flexible support to people as citizens is what people want and it’s much more fulfilling

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