Title: Implementation of Self Directed Support in Wrexham 20072008
1Implementation of Self Directed Support in
Wrexham 2007-2008
- Compiled by Margaret Gregory and Elaine McGuire,
Wrexham County Borough Council 2008
2Introduction
- Wrexham is the first local authority in Wales to
use Self Directed Support as a method of
delivering social care to adults with a learning
disability. - This presentation contains the following
information- - What is Self Directed Support?
- Rationale for Wrexham to Implement Self Directed
Support - How does it work?
- Who benefits?
- New Partnerships Pilot how we started
- Implementation
- Top tips and things we now know make a
difference!
3What is Self Directed Support?
- Self Directed Support is the natural progression
from Person Centred Planning. - Giving people control over their own budgets.
- Choice about how and when they are supported
- Delivering quality services and giving people
more opportunities in their lives.
4What is Self Directed Support?
- Knowing up front what Social Services will spend
on my support and what services cost. - Being in control of how that money is spent.
- Being able to choose the activities I want to do,
rather than just a choice of services provided by
the local authority. - Being able to choose my own staff, how they
support me, when and where. I can choose people
who want to do the same things as me.
5Rationale for Wrexham to Implement Self Directed
Support
- Council requirement to effectively manage an
overspent learning disability budget - Improve quality, choice and flexibility of
services - Putting resources in the control of supported
people, families and carers - Enabling people to reach their full potential
- Building inclusive communities, where people
are valued and recognised for their contribution
6How does it work?
- Self assessment agreed by Care Co-ordinator
- Allocation of Budget
- Person centred plan (helpful, but not essential)
- Support plan agreed by Care Co-ordinator
- Options for managing the budget
- Agreement by resources panel
- Risk enablement panel if necessary
- Review
7Self Assessment
- Individual completes Self Assessment
Questionnaire with as much support as necessary
from someone who knows them well and understands
them. - This could include a family member, friend,
neighbour, advocate, support worker or
professional, eg. social worker or community
nurse. - The self assessment questionnaire is divided into
8 sections and is multi-choice. It asks
questions about how the persons disability
impacts on their life and they tick the statement
which describes them best.
8Allocation of Budget
- When the questionnaire has been completed, it is
checked by a social worker or community nurse to
ensure that the responses reflect the needs of
the individual. - Once agreed, the statements, which carry a
numerical value, are added up and a formula is
applied to work out the individual budget. - The person is then informed of their indicative
budget. This is the amount that Adult Social
Care will pay for the individuals social care
needs during that calendar year. - Once the person knows what their budget is, they
can then plan their support.
9Person Centred Plan
- People do not need a Person Centred Plan to have
Self Directed Support. - However, we have found that a great deal of
valuable information can be contained within the
Person Centred Plan. - This information can be used to underpin the
support plan. Person centred planning tools
develop dreams and ambitions and give direction
to the persons life. - Person Centred Plans are usually developed by the
individual and anyone they want to support them.
This may, or may not include family members,
professionals, advocates, support workers,
neighbours and friends.
10Support Plan
- This is a plan of how the budget will be spent to
meet the persons assessed needs. - The money cannot be spent on anything illegal or
anything that puts the money at risk. - The plan must keep the person healthy, safe and
well, promote their independence and not put
anyone else at risk. - Support plans should be creative, original,
individual and, as much as possible, community
based. - Support plans can be compiled by the individual
and anyone else whom they choose to be involved.
This may, or may not include family members,
professionals, advocates, support workers,
neighbours and friends.
11Support Plan
- The Resource Allocation panel will expect to see
the following issues addressed in a support
plan- - The plan should focus on outcomes and demonstrate
that people are taking part in meaningful
activities - That it keeps the person healthy, safe and well
- That it identifies the person/agency providing
the support - That it identifies who will manage the support
- That it identifies who will manage the individual
budget - It states the contingency amount
- It states the contingency plan and from where any
emergency cover will be provided - It identifies all risks and whether there any
unresolved risks - Financial assessment has been completed and there
is a monthly payment schedule
12The five ways of managing your budget
- Individual Budget Payment you receive an amount
of money into your designated bank account to pay
for your own support. - Indirect Payment you nominate a person you know
and trust (eg. A close relative), who opens up a
separate bank account to receive your funding,
and then they spend it on your support needs
following your support plan and your instructions - Independent Trust you set up an Independent
Trust whose sole purpose is to manage your
support and individualised budget the Trustees
spend the money based on your Support Plan and
considering your best interests - Individualised Service Fund you choose which
organisation you want to support you, make sure
they follow your Support Plan and provide the
support you want by people you want. They then
receive the funding directly from Adult Social
Care, but always account for that money to you,
as though it is your own money. - Care Coordination a) if you are unable to do
your own assessment, planning or organising your
own support, a Care Co-ordinator, in conjunction
with family members, friends, other professionals
and independent advocate to consider your best
interests, decides how the money is to be spent
and the Council award a contract/s to a support
provider. - b) If having undertaken your assessment and
support plan you do not wish to be actively
involved in managing your individual budget, the
Care Co-ordinator will make the necessary service
delivery arrangements.
13Approval by Resources Panel
- Once the support plan has been agreed by the
social worker or community nurse it is signed off
by the Team Manager. - It is then taken to the Resource Allocation
Panel, which meets weekly, for final agreement. - The finance department issue an individual budget
payment agreement form to the budget holder and a
start date is agreed.
14Risk Enablement Panel
- Issues of risk must be addressed within the
support plan. - We would expect any concerns about the plan to be
discussed with the relevant people at an early
stage and resolved. - If there are any unresolved risks, these can be
brought to a Risk Enablement Panel. Instances of
unresolved risk should be rare, it is not
anticipated that the panel will meet more than a
maximum of 4 times a year. - The purpose of the panel is to discuss the
unresolved risk issues and suggest ways of
reducing them to an acceptable level, recognising
that nobodys life is risk free. - The panel is made up of representatives from
Adult Social Care and the NHS, also the
Protection of Vulnerable Adults Co-ordinator and
anyone else involved in the particular case under
discussion. - In very rare instances, it may be necessary for
Adult Social Care to retain control of the budget
where severe risks cannot be resolved. In all
cases, Adult Social Care retains a duty of care
to the individual.
15Review
- Four weeks after the budget has started, a review
is held, to check that everything is running
smoothly. - Thereafter, reviews are held annually and the
self assessment questionnaire is completed again. - If the social worker or community nurse feels
there is a need to review more regularly, then
this can be recommended, eg. 3 monthly or 6
monthly. - If the budget has not been completely used up at
the annual review, the department will reclaim
anything over 20. This avoids panic spending
at the end of the year.
16Who Benefits?
- The Supported Person
- Their Family
- The Community
- Support Staff
- The Local Authority
17The Supported Person
- I am in control of my own life
- I have real choice I can design a tailor-made
package of support - My money can be used flexibly for equipment or
activities. I can use it creatively and get real
value for money - By choosing my own staff and employing them if I
want to, I am able to have continuity and
consistency. I get to know them and dont have
strangers supporting me
18The Supported Person
- I have my own income, which I can manage with
support if I need it and have the same rights,
responsibilities and opportunities as other
citizens - The same process is used for everybody in working
out budgets. I know that it is fair because it
reflects how my disability affects me, and other
peoples budgets will reflect how their
disability affects them - I have the chance to be involved in my own local
community. I can use my life experience, my
abilities and gifts for the benefit of other
people with learning disability and the whole
community
19Families
- Involvement in support planning process having
a real say / real input into the design of
individuals support package, channelling
energies into achieving positive outcomes instead
of fighting the system - Re-assurance and peace of mind that their family
member is receiving the right level of service - Service provided by support workers who really
care about the person they are supporting and
want to give them the best life possible, which
means promoting their independence - Shaping the future of social care by not settling
for any service which is not truly person centred
20Community
- Benefits from skills, attributes and abilities
contributed by people with learning disabilities,
which are currently an untapped resource - Creating a truly inclusive community where nobody
feels left out because of their disability - There will be economic benefits to the local
community, as people will be more inclined to
spend money locally, contributing to community
regeneration
21Support Staff
- Staff matched to individuals and their
activities, resulting in staff who want to be
with the person, doing activities that they are
also interested in. - Greater job satisfaction evidence of improved
quality of life for supported person - More opportunities for staff and greater
flexibility, suiting both staff and individuals - Staff not needing to be trained in areas, which
are not relevant to the person
22The Local Authority
- Creative use of funding as individuals often get
better value for money than the local authority - Fair and transparent assessment process
ensuring equality for all - Control of Adult Social Care budget
- Streamlining administrative processes releasing
time for professionals to spend on therapeutic
interventions with individuals and families - Implementing Self Directed Support will mean that
local authorities will comply with policy and
guidance for individuals to be involved in the
design and delivery of services - Reduction in bad debt re. charging policy, as it
is deducted at source
23New Partnerships Pilot
- Pilot - New Partnerships
- 2005 - 2007 trained families and individuals in
Person Centred Planning - 2007 4 families agreed to pilot having an
individual budget for their family member - Budget was based on average English figures
- Families were encouraged to think creatively
about how the funding could be spent to get best
value for money
24Stories from New Partnerships
- Value for money - Two young ladies who are
friends and each have their own budget, when
going to activities together pay staff member a
slightly lower rate per hour each, eg. if
supported 1-1, staff are paid 8 per hour and if
supported together, each pay staff member 5 per
hour - Development of personal skills one of these
young ladies has significantly improved her
skills in interpersonal relationships due to
having control of her budget and being able to
make choices
25Stories from New Partnerships
- Communication One young man, who has Autism,
has no verbal communication. His family were
unable to work out his communication system.
Using funding from his budget, an expert in
communication spent 2 days doing intensive
interaction with him. He and his family are now
able to communicate with each other. This has
reduced challenging behaviour because of
frustration and family life is so much easier. - Creative use of money Rather then employ 2
staff members to support him in the water, a
swimming instructor was engaged with a support
worker. This resulted in the young man learning
to swim, something he has wanted to do for many
years.
26Stories from New Partnerships
- Quality of life Emma had serious health
problems, meaning that some days she was well and
able to enjoy life and other days she was poorly
and confined to her bed. Under the traditional
system, if she was unable to give 24 hours notice
to cancel her support, she lost it. This was a
cost to the local authority. - The activity which she enjoyed most, karaoke at
the local pub, was a problem, because of the
support workers shift system, which meant she
had to leave at 9.45pm. - With her individual budget she was able to employ
her own staff for the days and times when she was
well and this meant that she was able to stay
until the end of the karaoke. - One significant outcome was Emmas ability to be
part of her local community and have her own
circle of friends.
27Bid for Resources
- Following the success of New Partnerships there
was a recognition that individual budgets could
benefit individuals, the family and the local
authority in terms of budget control. However,
the learning disability service did not have
sufficient internal resources to take it forward. - With support from the Leader of the Council,
Chief Officer and Assistant Chief Officer a
presentation on Self Directed Support was made to
WLGA and SSIA. This resulted in a successful bid
to SSIA for additional resources. - Funding for a one year Project Officer post and
some consultancy provision was granted.
28ImplementationAgreement from Council
- Approval from Council (Scrutiny and Executive
Board) to implement Self Directed Support as the
model for delivering social care to adults in
Wrexham with a learning disability - Regular updates through presentations to Members
- In Wales, Wrexham is regarded as the pilot
authority for Self Directed Support
29ImplementationStructures
- Steering Group a multi-disciplinary,
multi-agency group with organisational influence
to drive it forward - Working Group people who, at an operational
level, could develop guidance, documentation and
processes - Appointment of Project Officer on a one year
fixed term contract - Agreement with Paradigm to provide consultancy
support - Establishing the pounds per point for Wrexham
30ImplementationPounds for Points
- Desktop exercise cross section of people with
high, low and medium needs. Used RAS4 - Agree percentage investment (top-sliced budget)
allows for new services and transitional
payments. Members of our authority then agreed
the percentage investment. - Integrity check essential to get pounds for
points set at level which does not cost authority
any more money, but also allows for growth. - Pounds for points may need adjustment and this
can be done using the RAS 5 tool.
31Implementation Training
- Training Community Learning Disability Team to
work with a new system. - Initially the training concentrated on the
concept and values of Self Directed Support. -
- Training involves the acceptance of the shift in
power from the practitioner to the
individual/family and the change in culture that
this implies. - As the system and processes evolve, additional
training is provided to the team and full
training to new members. - Training is both formal and informal, as an
informal drop-in session is held weekly to
support practitioners.
32Implementation Awareness Raising
- Awareness sessions for other stakeholder groups-
- Council Members
- Team managers in other areas of Adult Social Care
- Staff who provide back office support, eg.
Finance, Audit, Contracts, Human Resources, Care
Brokers, Commissioning Team
33Implementation Support and Guidance
- Support and guidance for individuals and
families- - People interested in Self Directed Support are
invited to a series of 3 training sessions, which
cover the following topics- - Understanding what Self Directed Support is and
how it works - Ensuring that people are aware of all the
options, in terms of compiling support plans,
staffing, creative use of funding and budget
management - Underpinning knowledge to enable families to
compile support plans themselves if they wish to
do so. Further help and support is available
from the local authority or an independent broker - Weekly drop-in support session available for
individuals and families to progress their
support plans
34Implementation Work with Providers
- Providers
- Both in-house and external providers of services
will be affected by the implementation of Self
Directed Support - Early in the process, Paradigm provided a
training day to make providers aware of the need
to adapt and change their businesses in the light
of new demands in the marketplace. - Attendance by the Project Officer at provider
forums to update and inform of progress. - Free places funding at external conference for
providers by the local authority. - Providers Fair to give opportunity for providers
to engage with individuals and families and to
showcase their unique selling point.
35Implementation Changing Culture
- How do we make Community Inclusion really WORK?
- Set up a Community Inclusion Team (CIT) to
address the following- - Barriers to inclusion
- Lack of knowledge about whats available
- Resource An electronic interactive up-to-date
database of all community activities, groups and
organisations. Maintained by the Community
Bridge Builder (CIT) - Lack of appropriate support to engage in
meaningful community activities - Resource One to one support commissioned where
appropriate through resource panel or SDS budget - Resistance from community groups
- Resource Staff from CIT will engage in
discussion with groups about their worries and
fears and will support them to understand the
positives of including people with disabilities
36Communication Strategy
- Formal reports and submissions to committee to
take project forward and to report on progress - Distribution of minutes of Steering Group
meetings - Informal communication taking the opportunity
whenever possible to talk about Self Directed
Support - Open days drop-in between 10am and 4pm to
obtain information and an opportunity at the end
of the day to hear a presentation from someone
who has their own budget - Media engagement good news stories to educate
the public about Self Directed Support
37Budgetary Considerations
- Financial profiling
- Early intention to select packages of support in
order to keep a balance between high and low cost
services and manage the financial profile. - Effective use of funding streams-
- Should start with a benefit check
- ILF must be applied for where someone is eligible
and this will be included in the indicative
amount from Social Services - Supporting People must be applied for if eligible
and will be added on to indicative amount - Health early identification of health needs by
MDT and application for joint funding. Again,
this will be added on.
38Working Documents
- Process Flowchart
- A visual guide for practitioners to implement
Self Directed Support - Resource Allocation Questionnaire
- Simple tick-box, multi-choice questionnaire to
assess how the persons disability impacts on
their daily life - Guide to Individual Budgets the rulebook
- What the money can and cant be spent on
- Simple and easy to understand
- Checklist for Resource Allocation Panel
- A tool for practitioners to use for panel
submissions - Risk Enablement Guidance Referral Form
- Process for Risk Enablement Panel for
unresolved issues between supported person and
Care Co-ordinator - Individualised Budget Payment Agreement
- The agreement between the local authority and the
person managing the budget
39Top tips and things we now know make a difference!
- Index to Top Tips
- Strategic Considerations 1 4
- Being Person Centred 5 8
- Management Considerations 9 17
- Changing Culture 18 22
40Top tips and things we now know make a difference!
- Support of senior management and council are
essential to success - Accurate pounds for points depends on a robust
desktop exercise and contingency amount for new
service users and transition. Dont feel that
the historical data has to be perfect before the
pounds for points are set. - The Executive Board Report to the council should
not state an exact amount for pounds for
points, as the amount may need to be amended at
a later date. - Dedicated co-ordinator time. Introducing and
implementing SDS cannot be done on the back of
the day job. As implementation gathers pace,
management recognise that a team of people is
required if the pace and quality of change is to
be sustained. We would suggest the following
members of the team - SDS Co-ordinator
- Assistant Co-ordinator (mainly to assist with
writing support plans) - PCP Co-ordinator
- Administration Assistant
- Additional Finance Officer time
41Top tips and things we now know make a difference!
- A person centred culture is essential and if the
authority has not already developed this, it will
need to do so in order to implement Self Directed
Support. This is a whole culture change where
there is a transference of power from
professionals to individuals and their families. - Person Centred Planning is very helpful, as
underpinning information for support plans can be
incorporated and built upon. Although, a person
centred plan is not essential for Self Directed
Support. - Encourage creativity by not providing a ready
made list of activities or services for people to
purchase. - Good news stories for the media early in the
process help to build awareness and confidence of
SDS as a new way of allocating resources. There
are two main messages that need to be conveyed by
the media using real life stories. The first is
an assurance that public funding is being spent
responsibly and effectively to obtain value for
money and the second is that individual budgets
improves the quality of peoples lives.
42Top tips and things we now know make a difference!
- Tenacity changing processes and culture is
difficult. Climb every mountain! - Communication is key. Take every opportunity,
both formally and informally to communicate the
message that Self Directed Support is the future
of Adult Social Care. Dont make assumptions
that professionals will automatically understand
the concept. - Target Setting Dont be over-ambitious.
- Wrexham set monthly targets for achieving SDS
packages far too high 10 per month. In the
early months, this has proved to be unachievable
as in order to retain the ethos of Self Directed
Support, it is essential to be led by the
supported individuals. This time-frame can
vary depending on levels of understanding and
skills. Also, it is impossible to set up a
perfect system immediately and time is needed to
develop systems which suit the local situation. - Being clear with all concerned that once the
budget has been set, any services must be
delivered within that allocation, unless needs
change.
43Top tips and things we now know make a difference!
- Self Assessment is for people who live in the
community, not residential care. However, if a
young person is in a residential college
placement, Self Directed Support can be provided
for college holiday support. The allocation of
funding would be worked out pro-rata for the
weeks they were not at college. - It is very helpful to include key stakeholders,
such as Finance and Audit in the Steering Group
from the beginning of the process. This avoids
having to change processes in order to
accommodate audit and finance requirements at a
later date. - Make good use of more experienced authorities,
learn from their mistakes and build on their
successes. - Engage a knowledgeable, reputable consultant to
advise, support and be your critical friend. - Accept that although you may wish to select the
order in which people develop their individual
budgets, this may not be possible. In Wrexham we
wanted to keep a balance between high, low and
medium cost packages in order manage the budget.
However, Self Directed Support tends to grow in
an organic way, with people coming forward who
want to make significant changes in their lives
these will be your good news stories!
Eventually, we decided to go with the flow and it
seemed to work.
44Top tips and things we now know make a difference!
- Personalising and modernising in-house services
is key to ensuring that individuals have real
choice and control when purchasing their support,
for example- - Training people who receive support to quality
check services. In Wrexham a team of people
receiving supported living, quality check each
others services in line with the Reach
Standards. - Training individuals to recruit and select their
own staff. Training includes Equal Opportunities
legislation, interview questions and techniques,
evaluating responses. - Community inclusion maximising opportunities
for people to truly integrate into their own
local communities.
45Top tips and things we now know make a difference!
- Be aware that people may not wish to be directly
responsible for, or involved in, the writing of
their support plan, the management of the budget
or the management of the service. Independent
brokers can be employed by the individual to
assist with all these tasks. - Compliance with the Corporate Project Management
process. This could have been viewed as having a
negative impact, but was actually a positive
experience. The Corporate Risk Assessment
meeting provided people with an opportunity to
voice all their concerns and fears about risks to
the authority. Risk reduction strategies were
discussed, including identification of current
control measures and how the residual risks would
be managed. - Currently Self Directed Support sits outside
traditional Social Services / Adult Social Care
systems, however learning to engage with these
tried and tested Corporate systems, brings a
validity and strength to the new processes. - In order to successfully implement Self Directed
Support, we believe it is important to engage
with peoples intellects and their emotions.
Self Directed Support has a high value base and
there is a need to understand how the system
works, but also to engage with the life changing
experiences of people who use Self Directed
Support. Use powerful stories.