Steering My Own Course Implementing Self-Directed Support in Cambridgeshire Mike Hay – Head of Transformation, Adult Support Services Lyn Jenkins – Community Development Manager

Putting People First

Putting People First (Dec 07)  By signing this historic protocol, we accept our shared responsibility to create a high quality, personalised system which offers people the highest standards of professional expertise, care, dignity, maximum control and self-determination.

Putting People First  In the future, we want people to have maximum choice, control and power over the support services they receive.

Putting People First  Over time, people who use social care services & their families will increasingly shape & 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.  The state & statutory agencies will have a different not lesser role – more active & enabling, less controlling.

7 Government Outcomes for Social Care  Improved health & well-being  Improved quality of life  Making a positive contribution  Choice and control  Freedom from discrimination  Economic well-being  Personal dignity

Pilot in Learning Disability Partnership (LDP)  2006 work started on how to deliver a self-directed approach, in partnership with service users and family carers  Worked with Paradigm consultancy initially, contributing to early national learning  Led to successful bid to work with “inControl” as one of only 10 first wave of Total Transformation sites  Through Putting People First, this approach is now Government Policy – all Local Authorities to deliver Self-Directed Support and allocation of Personal Budgets

What is Self-Directed Support?  Focus on what is important to the person, and work from there.  Starts with (supported) self assessment of social care needs and life aspirations  Allocate a personalised budget to meet confirmed needs  Agree the individual’s “support plan” owned by them, rather than write a “care plan” owned by the Council  Citizen (and family carers) perceived as the expert in their own life  Designed to meet the 7 outcomes

Methodology  inControl Questionnaires to -  individuals using services  Family/informal Carers  Care Managers  + focus groups -  Politicians and Reference Group  Care Managers

Example Questions 1: Service User What are the major needs that your support is helping with? Please write ‘1’ in the box next to your most important need. If you have another need you want to mention, please write ‘2’ in the box next to this second need. Physical impairmentSensory impairment Learning disabilitiesMental health difficulties Older personCarer Other need (please write in)

Example Questions 2: Service User In the past year, have you felt more safe or less safe when you go out? Feel more safeFeel the sameFeel less safe Has the support you’ve got from Cambridgeshire County Council made a difference to how safe you feel when you go out? It has helpedIt has made things worse It has made no difference

Example Questions 3: Carer To what extent do you now feel you have the support you need to continue caring and remain well? Less than beforeAbout the same as before More than before

Example Questions 4: Carer What are the important things to you in your caring role? (Please comment) Did the personal budget have an effect on these, if so how ? (Please comment)

Example Questions 5: Care Manager

Graphs from evaluation report – Service Users

Graphs from evaluation report – Family Carers

Key Messages of Steering My Own Course  Importance of high quality information and support to individuals and families  Support Planning process with clear outcomes  Positive outcomes for individuals and family carers  Need to engage with, and develop, local communities to be able to respond to the needs of all their citizens  People keen to have greater control, and staff enthusiastic to work in this liberating way

Lessons for practitioners  Stick to the process, indicative amount and then plan not the other way around  Initially some practitioners had a little difficulty with how people wanted to spend their money - understanding of substantial and critical need - what previously wouldn't have been sanctioned (holidays, ironing, shopping) is now possible  Individuals and families are likely to need more support as they get to grips with having more choice and being in control  Honest conversations with individuals and families may make practitioners feel exposed - no hiding behind panel decisions  Learning to trust their professional judgment, SQ scores and validation  Reviews are outcome focused so have real meaning for individuals

General Observations  SDS is not just about the money - planning is what holds everything together  Same process whether a Direct Payment or managed for the individual (ISF)  A DP is still the only way to make a payment to an individual only now it isn't about hours of support but a sum of money to meet need  DP rules still apply, however flexible in terms of monitoring and recording - guidance where there may be doubt as to robustness of ability to manage

General Observations  An organic process that takes time to evolve - not perfect from day one  Involvement of practitioners in the development of the system is new to many and some have found it unsettling not to have a rigid system - an early comment was that we shouldn't have started until everything was tested and in place  An early example of financial misuse led to a practitioner being very critical of the process  Managing change - led by those currently in practice - critical to the moving on process - very early buy in from locality managers gave ongoing support and credibility to the new system

Comments from Parents  He has an opportunity to shine and to bring enjoyment and awareness to our local and more far reaching community. He has amazed us in every way..

Personal Budget – what it means to us  Fantastic  Flexible  Life changing experiences for the better

“Personal Budget is the best way to give a better life.”  to those who most need it.  Now that some of us have experienced this process, we should think about how we can help other people.

Continuing Development – Big Issues  Safeguarding – checking and double-checking that we are doing all we can  Level playing field for all – individuals and service providers (including in-house)  Urban/rural issues?  Does the allocated Personal Budget work – are we delivering better outcomes?  Financial sustainability for Council (and Partners)  Must not sacrifice quality for speed during implementation

Staged Implementation with rolling Review/Learning Points  Learning Disability Partnership from April 2009  Review June 09  Physical Disability from June 2009  Review July 2009  Older People from August 2009  Reviews October and December 2009  Mental Health from January 2010  Reviews February and April 2010