An Introduction to Personalisation and Services for Vision Impaired People

Pamela LacyProject Manager with RNIB Evidence and Service Impact

Learning Objectives

• To describe the concept of personalisation

• To describe the context of personalisation in health and social care

• To gain knowledge of some of the terminology associated with personalisation

• To consider what personalisation might mean for the Social Care Sector and Vision Impaired People

What is Personalisation?

Veronica Alalade/L&D/Docs/May 2009

Personalisation

Personalisation means thinking about public services in a different way, starting with the person not the service.

• This means thinking about adult social care in a different way too, starting with the person in need of a service rather than the service itself

• It is part of the government’s vision to empower citizens to shape their own lives and the services they receive

• It is a major part of ‘Putting People First’ – a government initiative to transform adult social care

The commitment:

10 December 2007

Putting People First set out:• A “shared vision and commitment to the

transformation of Adult Social Care”.

• “People who use social care services and their families will increasingly shape and commission their own services”

• “The state and statutory agencies will have a different not lesser role – more active and enabling, less controlling”.

A Definition

“Personalisation means putting the person’s needs first to give them more

control in their life.”

Personalisation: an Easy Read guide

Social Care Institute for Excellence 2009

Where has personalisation come from?

Veronica Alalade/L&D/Docs/May 2009

• The service user movement which emerged in the 1970s and the social model of disability

• Policy thinking and ideas of researchers, policy analysts and think tanks e.g. Charles Leadbeater (Personalisation through participation 2004b)

• The practical work of in Control

Background -1

• Social work values – human dignity and worth; social justice; service to humanity; integrity and competence (BASW, 2002)

• Public policy – personalisation is a central feature of the government’s agenda for public sector reform

• Direct payments – in practical terms a driving force behind the agenda has been the experience of direct payments

Background - 2

• Independence, Well-being and Choice (2005)

• More explicit in the subsequent white paper Our Health our Care our Say: a new direction for community services (2006)

• Putting People First - December 2007

Public Policy

• Local Authority Circular ‘Transforming Social Care’ issued by Department of Health (DH) January 2008

• Social Care Reform Grant makes £500m available to all councils providing Adult Social Care

• Local leadership and planning is crucial• Delivery of personal budgets stated as essential

part of the overall agenda

Clear Central Government Agenda

Some Essential Terminology used in Personalisation

Veronica Alalade/L&D/Docs/May 2009

A Direct Payment• A cash payment paid directly to you, so you

can acquire your own support, rather than having this delivered by the Local Authority Adult Social Care dept.

• It can be used to contract with a private or voluntary sector agency or by hiring your own personal assistant for your social care

• It is one of a range of options for people getting a personal or individual budget

A Personal Budget• This is a clear, up-front allocation of

money made up solely of social care funding that you can use to purchase support from the public, private or voluntary sector

• It is given to users after an assessment, and the amount of money allocated should be sufficient to meet their assessed needs

• Current policy uses the term "personal budgets" for adult social care funds only

An Individual Budget (IB) -1• This involves being clear with the person

from the outset how much money is available to meet their needs and allowing them maximum choice over how the money is spent and on what

• An IB can combine several funding sources that you can use to design and purchase support from the public, private or voluntary sector

An Individual Budget (IB) -2• Initially, individual budgets (IBs) were for

social care funds only

• Subsequently, in some areas, especially the 13 Department of Health IB pilot sites, emphasis has been placed on merging social care funding with other income streams to produce an “individual budget”

• E.g. Supporting People and funds for equipment

An IB Verses a Personal Budget

Individual Budgets (IBs) differ from personal budgets because they cover a multitude of funding streams and not just adult social care e.g. Supporting People, Disabled Facilities Grant, Independent Living Funds, Access to Work and community equipment services.

Practicalities

• IB is good for buying difficult to fund items like computer software

• You can fund a personal reader for about a year and a half for the cost of a mid range CCTV

• Communicator guide schemes provide a good template

• Training/accreditation for personal assistants

Why do we need to change?

The present System is:• Based on matching a limited range of services to people’s assessed

needs• Costs are rising and services are under increasing demographic pressures• Many people assess the current situation as being ‘in crisis’• The current system of social care is not sustainable

• The current system of social care is not sustainable.

Local authorities' response:• Looked to make efficiency savings

(including shifting large volumes of in-house services to the private and voluntary sectors)

• Changing eligibility criteria to restrict access

• The current system of social care is not sustainable

Beyond ‘Community Care’ “The time has now come to build on best

practice and replace paternalistic, reactive care of variable quality with a mainstream system focused on prevention, early intervention, enablement, and high quality personally tailored services.”

HM Government (2007) Putting People First: A shared vision and commitment to the transformation of Adult Social Care.

Example:

Ambridge Adult Social Care spend £2m each year on a block contract for domiciliary and respite care delivered in the community.

This funding is paid under a service level agreement to their local service provider. It buys personal care, respite beds and occupational therapy.

But what does it actually achieve for the people using those services?

Commission for outcomes and outputs is:

Judging success by the tangible benefits achieved by the people that the services are designed to serve.

This involves moving away from counting the services given e.g. the number of hours of domiciliary care or respite beds available, to counting the desired outcomes achieved e.g. being able to maintain an independent life or have a break from caring by going on holiday.

How will Personalisation be Different to the system we have now - 1?

• Person-centred

• Choice and Control to the end user

• Outcomes not Services

• Independence

• Prevention

• Early intervention

• Self - Assessment

How will Personalisation be Different to the system we have now - 2?• The tailoring of services to respond to

individual needs, instead of individuals having to fit in with a service

• Finding new collaborative ways of working and developing partnerships, which then produce a range of services for people to choose from

• Greater recognition and support for carers

What is personalisation about in practice?

Veronica Alalade/L&D/Docs/May 2009

Fair Access To Care - FACS• Eligibility Criteria

• Low, Moderate, Substantial, Critical

• Most set at Substantial and Critical

• DH consultation on the revision of the Fair Access to Care Services guidance to support councils to determine eligibility for social care services within the policy context of personalisation and prevention. Responses required by 6th October 2009

Self Assessment• A key element in personalisation; an

individual assesses their own needs and decides on what outcomes need to achieve

• You need to complete a self-assessment form explaining what help you need. Adult Social Care must make the form available to you in an accessible format

• The form is used to decide what level of need you have and how much money to pay you based on a Resource Allocation System (RAS)

Resource Allocation System• Some areas have developed RAS from

experience gained from operating the In Control scheme

• Some areas have developed RAS from scratch. Still ongoing and evolving (Oldham now on version 6)

• At present no national scheme but guidance available through DH regional personalisation teams

What is the aim of a Support Plan?

A Support plan has to answer these questions:• What is important to you? • What do you want to change? • How will you arrange your support? • How will you spend your money? • How will you manage your support? • How will you stay in control? • What will you do next?

Self-directed Support• A term used to describe how a support plan

is designed and led by the service user and concentrates on outcomes rather than services

• the level of support is agreed in a fair, open and flexible way

• the individual should control the support and financial resources for their support in a way that they choose

What are the key issues for the social care sector as a whole?

Veronica Alalade/L&D/Docs/May 2009

• A universal information, advice and advocacy service for people needing services including those funding their own care

• Self-directed support becoming mainstream• Viewing Telecare as integral rather than

marginal• A commissioning process that encourage

services offering high standards of care, dignity, maximum choice and control

The personalised social care system will need to meet these objectives:

Veronica Alalade/L&D/Docs/May 2009

• a fair and transparent system for allocating resources

• personal budgets as an option for anyone eligible for publicly funded support

• an increase in the uptake of direct payments• supporting people to remain in their own homes

for as long as possible, while combating potential isolation

• ensuring people, their carers and families have a collective voice, influencing policy and provision

The personalised social care system will need to meet these objectives:

Veronica Alalade/L&D/Docs/May 2009

What does personalisationactually mean forVision Impaired People?

Veronica Alalade/L&D/Docs/May 2009

Learn about and apply the Core principles of Personal Budgets

• Choice and control

• Upfront allocation of funding/budget Resource Allocation System (RAS)

• Choice of support for planning/brokerage

• Choice of delivery e.g. Direct payments or Commissioned Service

• Potential mix of funding streams

Influence the Transformation Agenda

• Personalisation

• Information, advice and advocacy

• Closer working between health and social care

• Joint Strategic Needs Assessments

• Emphasis on prevention and early intervention

• Outcome based assessment & commissioning

• Brokerage

Use the Successes • … seeing people who’ve had very, very

traditional style support for a very long time, living much more independent lives than they had done. (IB lead officer)

• People are actually living, not existing and they have stories that have changed the hearts and minds of not only the care managers but of the elected members. (IB lead officer)

Overcome the Challenges• I don’t think you will ever get a Resource

Allocation System that is accurate enough to say this is an entitlement-based system … I think it will only ever be indicative. (IB lead officer)

• Managing the tension between the long-term focus on outcomes of some individual budget arrangements with the shorter-term risk focus within the FACS approach was also noted as a challenge.

Raise Awareness of:

• Resource Allocation System (RAS)– Proper representation of sensory needs

• The FACS gateway– Fully represents needs and risks

• Support for people with low level needs– Care navigators

Help to engage with Local Involvement Networks and Commissioners so that we can:

– Improve care pathways– Achieve the best mix for people of

health/social care/3rd sector input– Shift choice and control from professionals

to users and carers– Users and carers become partners in the

commissioning process– Develop services people want to buy

Required LA Deliverables• By March 2011 Local Authorities need to

have made significant moves towards fundamental system wide change

• National Indicator (NI)130 is linked to Personalisation and is mandatory. To achieve this target, Local Authorities need to have a minimum of a 30% take-up of Individual Budgets by service users, by the end of the 2010/11 financial year

“Over time, people who use social care services and their families will increasingly shape and commission their own services. Personal Budgets will ensure people receiving public funding use available resources to choose their own support services – a right previously available only to self-funders.”

Putting People First – December 2007

Our Future?

• www.scie-socialcareonline.org.uk

• www.in-control.org.uk

• www.integratedcarenetwork.gov.uk/Personalisation

• www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/index.htm

• www.dhcarenetworks.org.uk/personalisation

• www.supportplanning.org

Contact Information:Patrick Haywood

RNIB

58-72 John Bright Street

Birmingham

B1 1BN

Email: patrick.haywood@rnib.org.uk

Tel: 0121 665 4243

Pamela Lacy

Mobile: 07528 531909

Email: pamela.lacy@rnib.org.uk

What do you think?

Veronica Alalade/L&D/Docs/May 2009