Adult Social Care Transformation and Supporting People SHIP Conference February 4 th 2010 Helen Duckworth London Borough of Brent ASC Transformation Team

Transformation of Adult Social Care Rising public expectation: Baby Boomers expectations Prevention and Flexibility Based on principles of citizenship Demographics : 1.7 mill more people will need care and support in next 20 years Over 85s to increase by 2.5% per year 25% over 85s will develop dementia Wealthier older people- more self funders in future One Third over 85s need constant care or supervision

New Model Advice and Information Council Funded Personal Budget Self Funders HELP TO ‘PLAN’ HELP TO NAVIGATE MARKETPLACE AND SECURE SERVICES ADVICE AND SUPPORT IF THINGS GO WRONG Ensure QUALITY & CHOICE of SERVICES Individual Direct LA held Service Fund OR Payment (£) OR budget OWN RESOUCRES ££ Assessments Residents in Need DEVELOP ACCESSIBLE UNIVERSAL SERVICES

What good looks like………………………. Universal Information and advice Targeted preventative support Self Directed Support and Personal Budgets Support in planning, purchasing and managing care Transformed System of Care and Support Independent, Safe and Valued lives Easy access to one stop advice and info Advice if things go wrong Help to plan Good support plans Services are flexible and responsive Less long term intensive support Managing risk and keeping safe Everyone empowered to make informed choices Transparent resource allocation Co-production Goals Operating Model A diverse high quality care market All sector workforce skilled and trained Sustainable finances supporting prevention, maximising value User and carer involvement embedded Systems support high quality services, dignity and safety Enablers

Understanding the terms

How are local authorities measured? Effective Partnerships with people using services, carers and other local people Self Directed Support and Personal Budgets Prevention and Cost Effective Services Information and Advice Local Commissioning

Effective partnerships with People using services, carers and other local citizens P eople accessing care and support and carers working in a co-productive relationship with Local Authorities and their partners at all levels in the design, planning and delivery of new personalised systems and services

Prevention and cost effective services Whole system approach to prevention, intervention and cost effective services. This includes the support available that will help any citizen requiring help to stay independent for as long as possible A key part of this is ensuring council-wide and partnership approaches to universal services e.g. leisure, adult education, transport, employment, healthy living and health improvement, housing.

Information and advice All citizens should be able to easily find locally relevant quality information and advice about their care and support needs in order to enable control and inform choice. Information should be available in a range of formats and through channels to make it accessible to all groups. Provision of information, advice and guidance should move from being largely developed from separate initiatives to a single coherent service strategy.

Local commissioning Councils need to ensure the development of a diverse and high quality market in care and support services to offer real choice and control to service users and their carers Commissioning in partnership with other local commissioners, providers and consumers of services balance investment in prevention, reablement with provision of care and support for those with high- level complex needs

Self-directed support, personal budgets and direct payments Systems in place to allow people who require social care support to find and choose quality support and control when and where services are provided and by whom

Targets for the Brent ASC transformation programme To support people to achieve independence and control over their lives 50% less people living in Residential Care by % of our service users on Self Directed Support by 2011 A significant increase in Direct Payments A transparent sustainable resource allocation system Increase in the use of Extra Care Sheltered Housing and other alternatives to residential care Single Point of Information and Advice about Care Services One service regardless of age for those who need Adult Social Care Re-ablement for all who can benefit

7 transformation work streams 1.Self Directed Support 2.Modernising Day Care 3.Modernising Transport 4.Re-designing Assessment and Care Management 5.Maximising Staff Efficiency 6.Developing alternatives to Residential Care 7.Developing effective commissioning

Where are we now? Re-design of Assessment and Care Management completed Over 600 people receiving Direct Payments with 100+ Personal Budgets in progress Staff Guidance and Training and Procedures Resource Allocation Developing SDS for Carers- co-production with carers Limited work with SP providers Developing Brokerage, Information and Advocacy Working with Home Care Providers – introducing flexibility and re-enablement within existing contracts Re-modelling transport and day services Introducing Intermediate Care and Re-ablement Re-modelling Community Equipment Stores Market development and Service user involvement Internet developments- Slivers of Time West London Commissioning

Personal Budgets One part of Transformation- not everyone will get a personal budget Self directed support is popular, cost effective and achieves better outcomes Nationally more than 40% of Personal Budgets are for Older People Focuses on achieving outcomes rather than services System in which publicly funded are brought ‘alongside’ private payers (in developed market) Transparency and portability- tell people the costs of their services- they start asking questions and making choices…..

Targets for SDS in Brent Client GroupSDS at Feb 09Target for March 2010 Target for 2011 Physical Disability Learning Disability Mental Health Older People Total

Information/ Advice/ Guidance SDS Operating Model 1 st Contact/ Screening Assessment 6 Weeks Reablement/ Early review Immediate Service/Early Review Self Directed Support and Resource Allocation System (RAS) Support Planning Brokerage Support Delivery and Budget Payment Review

Transformation Challenges Culture Change for citizens and staff and partners How much of our budget should go into Universal Services, how much to individuals? Quality Assurance of a dispersed market- avoiding micro mgt Safeguarding in a dispersed market Getting feedback from service users Providing information about services – role of internet/advocates/partners Developing the market – people will want traditional services until an alternative is there An alternative may be very attractive- increase in demand? Managing change in in-house services Expanding the resources- making use of social capital, supported living, extra care housing, technology to support people at home

Provider Implications 1. Impact for People using your services Offered Personal Budgets What role will you play- support, advice, advocacy, brokerage Conflicts of interest? Support to help people employ their own staff- training, pay-roll etc Range of services available for them to choose “”It is the principles of choice, voice and control which should underline what specialist housing and service providers deliver” (Denise Platt – Housing 21 - Building Choices part 2)

Provider Implications 2. Impact on Your Organisation Increased use of information advice and advocacy Preventative Services Services for the whole community Different Services – participate in ordinary life Financial Arrangements – Grants vs Contract Relate to service user not commissioner Outcome based support Changing role of commissioners Growth of Personal Care options

Service delivery model Staffing levels Role of scheme manager Flexibility in deployment of financial and staff resources? Duty of care? Risk and safety issues? Scheme sustainability Sustainability of communal spaces & facilities Work in partnership with local authorities Housing Provider Implications

Provider Implications- Opportunities Respond to gaps in the market- new, more varied preventative services Some block contracts offering wider range of services for very specialist and universal services Opportunity for new providers Private purchasing likely to increase as criteria and charges made by L.A’s increase? Improved relations with service users – less rigid timings and activities with personal budgets –appealing to excluded groups Getting to know the whole person- more focus on outcomes- staff and user satisfaction New ways of Working- IT opportunities Opportunities for joint purchasing by groups of users? (Up2us project – HACT)

Provider Opportunities- Not just home care and personal assistants Brokerage Support Planning Advice and Training for Self -Employed staff Direct Payments advice Holiday cover Register of staff willing to work as PA’s Managed accounts Support with outings and leisure Social Activities Small repairs Gardening Travel Support Housing Support Living a “normal life” Specialist support e.g. dementia

Provider Strategies 1. Focus on outcomes, gather outcome data and tell your success 2. Respond to what you know people want - re-think support work, people need help to get into work, make friends, learn new skills 3. Identify your Unique Selling Points 4. Build Personal Budgets into your systems- ring fence peoples budgets, core services and add-ons 5. Calculate costs accurately and develop a menu of services 6. Build Personal Assistance into your offer 7. Get everyone involved- finance staff, front line workers, board 8. Get involved with local people and Local Authority (co- production and phased introduction) 9. Share what you learn

Contacts in Brent Adult Social Care Helen Duckworth – ASC Transformation Team David Hardman- ASC Transformation Team Linda Martin- Head of Commissioning and Service Development Lance Douglas- Assistant Director, Quality and Support (Transformation Lead) Senel Arkut - Head of Care Management and Review Brent Mental Health Service Kofi Nyero- Learning Disability Partnership Clive Turner- Head

Further Information Implications of Individual Budgets for Providers (OPM August 2007) Commissioners and Providers Together: Citizens at the Centre (Andrew Tyson, In Control, June 2007) Local Authority Circular (DH)(2009)1: Transforming Adult Social Care (and links in this document to many useful articles) Making it Happen-Lessons learned on the introduction of IBs in a Provider Organisation (Jill Parker, KeyRing, 2008) (on InControl website) lists a wide range of the various support options that are generally available.