Individual Service Funds Colin Angel, Policy Director

United Kingdom Homecare Association Member-led professional association Represent 33% of UK’s independent and voluntary sector homecare agencies Promote high quality, sustainable care services so that people can continue to live at home and in their local community Provide campaigning, leadership and support

What is an Individual Service Fund (ISF)? The management of a service users’ personal budget to achieve agreed outcomes Council pays budget directly to the provider Provider arranges care according to the users’ wishes

Individual Service Funds for Homecare from In Control Authors:  Caroline Tomlinson (In Control)  Michelle Livesley (Helen Sanderson Associates) Sponsors:  UKHCA  Mears Care Limited Contributors:  People who use services  Wirral and Lancashire councils Get the publication from In Control [Link]

Where ISFs fit with Government policy White paper “Caring for our future”:  Services close to home  Greater choice and control The Care Bill:  Commissioning for wellbeing  Personal budgets as an entitlement  Direct payment as the preferred delivery method

ISFs and degree of control (for illustration purposes) Council commissioned service Council or 3 rd party managed personal budget Direct payment to buy services Individual Service Fund Direct payment to employ personal assistant(s) Less individual controlMore individual control

Why is UKHCA supporting ISFs? Benefits for users, providers and commissioners Traditional purchase models don’t make best use of scarce resources  Prescriptive planning  Pressure on price & visit times

The impact of current funding on homecare visit duration Source: Angel, C (2012) Care is not a commodityAngel, C (2012) Care is not a commodity

How and ISF works (A simplified overview) 1. User receives personal budget allocation from council to meet outcomes 2. User designs their support plan with the provider 3. Budget is paid to provider on a regular basis  User can buy additional services, if desired 4. Provider delivers the service  including buying services from elsewhere, if necessary 5. Provider able to account for how the budget is spent in “near real time” 6. Council that desired outcomes are achieved

The relationships within an ISF Specifies compliance requirements and obligations 1. Agreement & funds What is provided and when 3. Support Plan Statement of amount paid and user contribution 2. ISF details Council Provider Service user

The benefits for… People who use services Can increase chance to remain at home Reduces implications for the individual of:  Managing a direct payment  Becoming the direct employer of a PA Greater control over service  Individual can prioritise what's most important for them  Reduces "time and task” / inflexible commissioning Similar control as enjoyed by private purchasers Potential to be used by people who lack capacity  With appropriate support and advocacy

The benefits for… Homecare providers Offers greater flexibility:  User and provider can negotiate care plan to find ‘best fit’ between choice and resources  Avoids prescriptive or inflexible plans, with unnecessary authorisation procedures for minor changes Greater assurance of payment:  Avoids credit control costs, reduces write-offs  Better cash-flow, with predictable income Higher satisfaction for customers and staff Similar processes to private-purchase work

The benefits for… Local authority commissioners Can create a fast-track process to get people onto personal budgets Has the assurance that outcomes are defined  Agrees the outcomes with the person using the service  But leaves the detail how and when to the experts Reduces contracting effort  But savings need to be passed to providers, who take on this role

People with an ISF should be able to say… “I am fully involved in decisions about my own support and how the wider service develops” Co- production “I choose how I am supported and my support workers know this is important to me” How? “I get support on the days and at the times that are right for me” When? “I choose who I want to support me. My support workers know me and I know them” Who? “I am supported where it makes sense for me; at home and out and about” Where? “I can use my hours/budget flexibly and can choose what I am supported with” What?

Some practical considerations How the payment made?  In advance or arrears? Is users’ contribution paid to council or provider?  Provider-collection is higher risk, but may increase QA Need a system for dispute resolution  Eg. missed visits, or user not at home when expected What is the price?  Management costs different to high-volume contracts Develop experience in responsive plans  Especially if not already supporting self-funders

Making ISFs work in practice ISFs need to be an available option to all Willing providers must be identified and able to deliver Effective contracts need to be in place  All parties must understand their responsibilities  A specimen from Lancashire included in paper Monitoring to ensure that outcomes are achieved  Reviews 6-weeks to check bedded-down, then annually, or when needs change Trust is required between councils and providers

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