INDIVIDUAL SERVICE DESIGN WORK WITH COMPLEX* INDIVIDUALS IN THE NORTH EAST CONTACT: PAM LAWRENCE ( ) * Autistic Spectrum Disorder, Learning Disabled, Challenging Behaviour, Mental Health Issues INDIVIDUAL SERVICE DESIGN WORK WITH COMPLEX* INDIVIDUALS IN THE NORTH EAST CONTACT: PAM LAWRENCE ( ) * Autistic Spectrum Disorder, Learning Disabled, Challenging Behaviour, Mental Health Issues

Geographical Spread 3 ISDs prepared 5 ISDs prepared 1 ISD prepared 7 ISDs prepared Discharge process has begun for 11 individuals New/revamped services are in place for 5 of them Evaluation of outcomes to take place during 2013

The Main Stakeholders COMMISSIONERSFAMILY MEMBERS CARE/SUPPORT PROVIDERCARE MANAGER/COORDINATOR ISD

ISD Outcomes Everyone’s ISD describes more independent and active life-styles, a variety of community based services/facilities, future aspirations and the nature of the support/housing required. Everyone’s projected costs have been reduced bar 1 Some individuals now receive a refreshed service from the same provider: some have moved to a new provider. Workshop participants buy in to the process including “safety management”. More referrals received than the current project can commit to.

ISD Findings No-one has created an Individual Service Fund yet: “old” rigid contracting is the default position. Dedicated multi-disciplinary input will be critical in new community based settings. 2 day workshops don’t provide the essential detail which needs to be added during the discharge process….. and beyond The “named lead” may not have the necessary status or clout to put the ISD and ISF into place.

What has worked for individuals and their families A feeling that they are being heard by all the professionals that need to listen. A feeling that their lives are considered important and that detailed planning is long overdue. An opportunity to be supported to pick the right provider for their son/daughter. Ensuring managers and support workers really understand their son/daughter. Has given hope for the future about a much better life that families hadn’t realised was possible. Having an experienced and inspiring workshop facilitator leads to feelings of trust in process.

Recommendations for the next stage of ISD work Dedicated resources are needed so that a good practice process is promoted with LA/PCT/CCGs in every locality where people are returning. Strong regional and local leadership needs to insist on the development of ISDs as the default position for complex individuals. The main stakeholders (individual, commissioners, family members/advocate, care co-ordinator, support/provider) all participate in the Individual Service Design workshops. Stakeholders working together to earn family and professional confidence in the creation of a “safe and sound” service. ISD awareness, training/support needs to be provided to stakeholders and clinical staff so that they believe that the individual is capable of leading a more independent, community based life.

Recommendations cont… Multi-disciplinary discharge processes and timescales are based on the collective agreement that the individual is ready to move on. National and local good practice guidance needs to be utilised by commissioners in order to develop a more diverse, well-resourced provider market. Budgets are pooled from the outset in flexible Individual Service Funds and accounting for expenditure is transparent. Individuals are given priority status in order to reduce waiting times on housing lists and a variety of housing options are considered. Providers need senior management buy-in and a shakeup in staff roles, selection, training and management. More high quality workshop facilitators need to be developed. New “approved provider “ facilitates or fully participates in the ISD design and follow up work.

Post Winterbourne View PCTs/CCGs need to commit to utilising savings made through current and future ISD work to build capacity and guarantee sustainability for stakeholders. Spread information about the plans and progress of local and regional ISD/Post Winterbourne work via existing networks (NEAC/local autism working groups, NETSwork, LDPBs, Health and Well-being Boards, LD Clinical Network, 'user groups' and family/carer groups). Capture data about future needs in JSNAs, Joint Health and Well- being strategies and joint commissioning plans. ISD and ISF are central to the re-provision of community based services that will be needed by some individuals on the register. Regional leadership needs to describe a shared principles and ways of working for this cohort of people so that LA leads and CCGs create new services which are “safe and sound”.

Post Winterbourne View cont… Dept of Health needs to allocate resources to support stakeholder partnerships which establishes new collaborative working post Winterbourne and for future individuals. Budgets for individuals need to be pooled and used to deliver every aspect of the ISD. Lead commissioners and care co-ordinators will need guidance on monitoring outcomes and agreeing actions if things are “going wrong”. The ISD process needs to be dove-tailed into the work stipulated in the concordat and other national/regional projects eg improving advocacy services, personal health budgets. A variety of new, existing and specialist providers need to be supported in new ways to develop services for complex individuals.