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What is happening in Britain?
Personalisation of Social Care
What happens in Britain?
Four countries England, Scotland, Wales and N. Ireland
Hospitals have closed NHS Campuses are closing Still lots of out of county placements Commissioning transferred to local authorities Mixed economy
Voluntary Sector, Private sector, some public sector
Mix of models Residential care, Supported Living, Self Directed
Support
Valuing People 2001
“To improve the lives of people with a learning disability and their families and carers, based on their rights as citizens, social inclusion in local communities, choice in their daily lives and real opportunities to be independent.”
Valuing People 2001
Valuing People Now 2008
What Valuing People Now is about
Improve the way we give services to people using them
Making sure change happens
Improve the services offered to people
Personalisation
What people do
Health
Housing
in Control
http://www.in-control.org.uk
Putting People First 2007
A shared vision and commitment to the transformation of Adult Social Care
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/DH_081118
Why Personalisation?
The present system is not working well for several reasons
It does not control costs well, especially when needs are perceived to be more complex.
It limits creativity, innovation and community development.
It discourages family and community support solutions
It does not result in a good alignment between individual level of needs and level of service.
But most fundamentally, by not telling people what level of funding they have available, it stops disabled people from deciding for themselves how they want to be supported
Personalisation - No longer if but how and when
SDS is a new model of social care. SDS is about individuals receiving a personal
budget that they control to meet their own care needs, rather than the current service led approach.
It has the potential to improve the lives of vulnerable people by offering them more choice and control.
SDS is planned to be rolled out nationally by 2012.
Social Care vs. SDS
Social Care Self Directed Support
Vulnerable people need professional
support
Vulnerable people should control their
own lives
Existing services work well
Support should be individually tailored
Money is safest in the control of the state
Money should be close to the individual
Family and friends are unreliable
Family and friends have a vital role to
play
Lessons from other Sectors, Greater Consumerism Means
Constantly innovating
Constantly improving product
Better quality
Better price
More individualised
Current resource allocation system
SDS resource allocation system
Options for receiving SDS with an individualised budget
Direct PaymentDirect Payment
(agent)Direct Payment
(trust)
BrokerIndividual Service
FundCare Manager
What is Service Brokerage?
Service Users + Financial Allocation
Informal Support
Provider Organisation 1
Provider Organisation 2
Provider Organisation
3
Service Broker
In Control sees Brokerage as a set of functions
Assisting the person to develop a vision of how he or she wants to live
Reviewing, preparing and/or identifying indicative costs of creating and implementing a support plan
Clarifying the person’s needs and expectations, including, in the light of the local authority’s assessment, eligibility criteria under Fair Access to Care
Identifying and applying for funding from all government and non-government sources
Supporting the Fair Access to Care appeals process if required
Identifying and enabling the person to access community resources
Assisting with funding negotiation with commissioners
Liaising and negotiating with support providers
Monitoring and evaluating support
Modifying existing supports or develop new ones
Mediating and resolving problems (as directed by the person)
A report on in Control’s Second Phase – Evaluation and Learning 2005 - 2007
Impact on the Market?
Good quality, flexible, innovative providers will prosper
Poor quality providers will fade Expectation that quality will go up and prices go
down Potential for development of a lot of informal
arrangements Marketing directed at consumers will be developed There will be opportunities for individual solutions
Seven steps to being
1. My money – finding out how much
2. Making my plan
3. Getting my plan agreed
4. Organising my money
5. Organising my support
6. Living life
7. Seeing how it worked
The Choice Support group at a glance
Current turnover circa £32.5 million
Support 750 people
Employ 1300 staff
Operates in ………………….
Wakefield Nottinghamshire Stockport Oldham Leicestershire Bedfordshire Milton Keynes Buckinghamshire Hackney Haringey Greenwich Lewisham Southwark Lambeth Bromley Sutton Merton Hampshire Southampton Portsmouth
Preparation 2004 - 2008
7 presentations by ‘in Control’, Paradigm managers (40+)
9 Managers attend Paradigm Brokerage for Change course
CEO joins ‘in Control’ CEO groupNew bespoke individual accounting
system developed and installedManagement re-organisation
Formula for identifying supportIf n ≠ 0
α = + x + y + (n-Σσ) + σ
Key
α = % split to be applied to staff costs
G = Grade
h = Shared service support hours per week (i.e. total support hours less all 1:1 & 2:1)
x = 1:1 hours per week
y = 2:1 hours per week
n = Night waking hours (70) shared between those individuals requiring
σ = Sleep in equivalent hours (19) shared between those individuals requiring
H = Total service support hours per week (inc. night support)
Σ = Sum of
(G/ΣG) x h
H
Dealing with resistance
“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new”.
Machiavelli
First steps in individualising services and reducing costs
Lincolnshire – RAS 4
Individual services for people who present significant challenge
What’s happening now?
Direct Payments SupportFinancePersonnel
Free Service Brokerage
Total transformation of a £7 million contract
Challenges
Managing traditional services alongside new Ability to change organisational culture Ability to change systems and structures Ability to make desired savings Loss of control Loss of business Serving many masters - responsiveness Workforce transition Marketing – looking both ways Total transformation of funding of social care required To make better use of all of the available money in the
system
Opportunities
Those organisations that are able to respond positively can expand their business.
Diversification – HR; Payroll; training; etc. Move away from contracting “culture” and
reliance on “good relationships” with those in power.
The credit crunch The opportunity to abandon the current failing
social care system for one that is fairer, more responsive and delivers what the customer wants