Lynne Dean DHSW Deputy Regional Director

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Lynne Dean DHSW Deputy Regional Director
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Putting People First

• Co-produced protocol setting out vision, aims and
  values guiding transformation
• Change through
• Co-production,
• engagement,
• consultation

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Universal services

• General support and services available to
  everyone locally, including
• access to information, advice and support

• transport
• leisure
• education
• health
• housing
• community services e.g. libraries, adult
  education
• Street scene

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Choice and Control
Self directed support, e.g.

• services available to meet peoples needs and
  those of their carers and families
• access to information and advice
• transparency of resources available

• individuals choose who provides that support and
  controls when and where the services are provided
• help to negotiate their support needs
• provide advocates to help people decide

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Early Intervention Prevention
Support available to assist people who may need a
little more help, their carers and supporters at
an early stage to stay independent for as long as
possible, such as to

• recover from effects of illness
• safely maintain home and garden
• training to get a job
• return to work training after a break
• start taking some exercise

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Social Capital
How society works to make sure everyone has the
opportunity to be part of a community, such as

• experience friendships and care that can come
  from families, friends and neighbours
• positive interaction
• participating in discussions about community
  life
• volunteering
• Community empowerment and user led organisations

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Commissioning providing for the whole population
People who dont want to approach Social Services
Self Funders
People with short term recovery rehabilitation
needs
People with LTC with health and social care needs
Learning Disability Mental Health
People entitled to NHS/CHC support
People not eligible for Social Care under FCS
People who are eligible under FCS
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Key Questions

• Who will be my future customers
• What services do we want to offer
• How will people know what we provide
• How will we be paid
• How will we ensure quality
• How will we retain staff
• What will our market share be

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Agreed and Shared Outcomes

• Should ensure people, irrespective of illness or
  disability, are supported to
• Live independently
• Stay healthy and recover quickly from illness
• Exercise maximum control over their life and
  where appropriate the lives of their family
  members
• Sustain a family unit which avoids children being
  required to take on inappropriate caring roles
• Participate as active and equal citizens, both
  economically and socially
• Have the best possible quality of life
  irrespective of illness or disability
• Retain maximum dignity and respect

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What proportion of the spend goes into
Residential Care?
High 71
National Average is 52
Difference of 45
Low 26
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Percentage of patients age 65 discharged to
residential homes
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PROPORTION OF COUNCILS LEARNING DISABILITY
RESIDENTIAL CARE SPEND AS A PROPORTION OF THEIR
LEARNING DISABILITY CARE SPEND
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Preventative interventions

Citizenship
General population
Information
Lifestyle
Practical support
Early intervention
Ongoing support / care needs
FACS eligible
Substantial needs

• Self directed support
• DP
• IB

Enablement
Crisis / flexible response

• Plan Chose
• Self / family
• Assisted by non-professional
• Broker with professional advice
• Care managed

Institutional avoidance
Complex needs
Timely discharge
Care managed and professionally delivered
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People choose less dependent options this is
typically more cost effective
TRANSFORMING SOCIAL CARE
Information
Crisis Response
Re-ablement/ POPPs
Transforming Community Equipment
Support Related Housing Assistive Technology
Commissioning and Brokerage
Models of Support Planning
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Putting the person in control

• Key issues
• What help do they want
• Who do they want to provide it
• When do they need it
• How would they like it to be provided

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Whole System Change Self-Directed Support
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Whole System Change Self-Directed Support
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Self Directed Support A 7 Step process

• Initial Contact Assessment
• Assessment
• Initial Personal Budget Calculated
• Support Planning
• Brokerage
• Authorization and Validation
• Go Live/ implementation
• Monitor and Review

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Individualised Budget Process
Assessment Eligibility Criteria (FACS) An
Upfront allocation of resources (egg Resource
Allocation System or RAS) Allocation of
Indicative Amount before planning



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Self Directed Support Personal Budgets

• Focus on Outcomes-
• different care plan, contract and payment systems
• Can include
• Direct Payments
• Block funded social care services - the person
  is in control, although the council pays the bill
• Access to the whole range of services available
  in the community

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Developing a Support Plan for Mr and Mrs Smith
who are in their late 80s.
Both want 24 hour cover for support in
emergencies Mrs Smith wants a sitting service so
she can go shopping Both want a hairdresser and
chiropodist to visit Mr Smith wants to go to
Church and to the pub with his wife but she cant
manage this without help Mr Smith has a colostomy
bag and needs support with this and to have a
regular bath and to keep his clothing and
bedding, the bathroom clean. Both want help
with housework , shopping, windows and the garden
Mrs Smith wishes to provide most personal care
Mr Smith is assessed and personal budget of 100
pw allocated
Housing Scheme provides lunches
Mr Smith has Attendance Allowance and lives in a
sheltered flat with warden support funded by SP
Mrs Smith has carers grant of 500 pa
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Approaches to Brokerage
Independent Broker
User Led Organisations
Paid Staff
Community
Individual Family
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Providing the service

• Existing community, voluntary and independent
  sector providers
• People can choose to employ and pay direct or can
  use services the council is commissioning.
• People can choose to pay people to help them
• People can ask for services not previously in
  local authority social care contracts.

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It not just about Direct Payments

• Within existing block contracts how can providers
  enable a more personalised service
• Move to an outcomes led process
• Choice of carer
• Choice of time
• Ability to change arrangements and bank time
• Control over task performed
• Putting the person in charge, not the council or
  the contract

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Universal Services and Safeguarding

• Mrs Jones- 92years
• Private pension and 100,000 savings
• Lives in own home
• Pays one woman to do cleaning and shopping and
  washing- 3 mornings a week- found by word of
  mouth.
• Pays for frozen meals
• Pays for taxis, hairdresser to visit, window
  cleaner and odd job man/gardener
• No support subject to inspection, council
  contract, or review by the council

• Mrs Fisher- 88 years
• Savings below 3000 and on state benefits
• Lives in sheltered housing
• Has community care package of 5 hours per week
  arranged by social worker council
• Meals on wheels
• All care subject to inspection, council
  contracts, and community care review

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Safeguarding Challenges

• Systems which provide safeguards but dont
  restrict choice for customers
• Systems that enable staff to acquire the right
  skills and the reputation they deserve
• Systems which focus on user and carer defined
  quality outcomes.. The Dignity campaign and Zero
  tolerance

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Reviewing

• Focus on outcomes not auditing
• Safeguarding
• Choice
• Quality user defined

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Other Challenges

• Focus on Outcomes not just Inputs
• Main customer is the person not the council..
  Whatever the money flow
• Reputation management
• Providing on line information
• Different payment routes
• More choice and flexibility

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New Models

• The market and small trader model
  micro-businesses
• The supermarket model - as a broker as well as
  a provider
• The Ebay model
• Co-operative and social enterprise models
• User led Organisations
• Neighbourhood Schemes

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Plan My Care
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Smart Pre Payment cards

• Use by Direct Payment Schemes
• Available to people without bank accounts
• Provide ability to do lots of small transactions
• Provide audit trail
• Reduce transaction costs

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How do IBs change the requirements for support
planning and purchasing?
IB Purchasing Power

• Requirements
• Good information tailored to customer
• Ability to negotiate with suppliers
• Forum to collaborate in purchasing
• Ability to plan support, purchase and contract
• Ability to provide feedback

• Requirements
• Manageable way of dealing with multiple customers
• Forum to collaborate

A customer at the centre approach and tools are
required
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Key Milestones

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Key Milestones
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Key Milestones
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QUIPP

• Quality
• Innovation
• Prevention
• Productivity

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The Quality Framework

Bring Clarity to Quality
Publish Quality Performance
Recognise and Reward Quality
Measure Quality
Stay Ahead
Safeguard Quality
Leadership for Quality
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The Context

• NHS scenarios include 15b-20b reductions
• LA scenarios include looking a 5 pa reductions

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Transformed Care System
Universal Services Information and
Advice Community Offer social capacity Holistic
checks Opportunities for work and education
Targeted Interventions Equipment and Aids to
daily living Intermediate Care and Re-ablement
Telecare Predictive Tools Supported
Housing Falls clinics and other
Care and Support Choice and Control Self
Directed Assessments Personal Budgets Advocacy
and Support Brokerage
Supply Commissioning the right range of
services Macro and Micro procurement Contracts
and Spot Purchasing Cost and Volume of
supply Direct Payments vs Council/ 3rd Party
Purchasing
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Thank you