Caring for our future Caring for our future: shared ambitions for care and support Emerging thinking: Personalisation November 2011

Caring for our future 2 Context Caring for our future: shared ambitions for care and support was launched on 15 th September and runs until early December. It is a discussion with people who use care and support services, carers, local councils, care providers and the voluntary sector about the priorities for improving care and support. The discussion has been jointly led by leaders from the care and support community and senior civil servants from the Department of Health and supported by small reference groups. The discussions have focused on the following six reform areas: – Quality and the workforce – Personalisation – Shaping local care services – Prevention and early intervention – Integration – The role of the financial services These slides represent key findings and emerging thinking from these discussions to date. They are not a statement of Government policy.

Caring for our future 3 Workstream: Personalisation What are the priorities for promoting increased personalisation and choice? – How could we change cultures, attitudes and behaviour among the social care workforce to ensure the benefits of personal budgets, including direct payments, are made available to everyone in receipt of community-based social care? Are there particular client groups missing out on opportunities at the moment? – What support or information do people need to become informed users and consumers of care, including brokerage services? How can people be helped to choose the service they want, which meets their needs and is safe too? How could better information be made available for people supported by public funds as well as those funding their own care? – How can the principles of greater personalisation be applied to people in residential care? Should this include, as the Law Commission recommends, direct payments being extended to people (supported by the State) living in residential accommodation? What are the opportunities, challenges and risks around this? – How could better progress be made in achieving a truly personalised approach which places outcomes that matter to people, their families and carers at its heart? What are the barriers? Who has responsibility and what needs to change (including legislative)?

Caring for our future 4 What needs to change (1)? The current situation Culture and attitudes are not delivering person-centred care universally. Health and social care services are not joined up. System transformation incomplete and is not delivering what people want. Access to information is diffuse and variable. Range of providers still delivering ‘traditional’ care and support. Where we need to be All the local authority functions (social care, finance, universal services) need to be aligned to support users/carers. People receive an appropriate level of support. Leadership and staff need to align to serve citizens. There needs to be good quality national information, dovetailed with that available locally. Local authorities need to create a more diverse market that meets people’s needs.

Caring for our future 5 What needs to change (2)? The current situation Users and carers are still not helped to influence what is provided and how. Financial pressures seen as an excuse for not delivering person-centred care. Innovation is there, but is not encouraged or best practice adopted. There is still a lack of professional engagement. Local authorities focus predominantly on those they directly support. Where we need to be Person-centred care is embedded across health and social care and it means the same. The workforce needs to be encouraged to be creative. People need to help, advice, support and assistance from professionals to deliver their goals. Assisting and helping all local people, including self funders, is the responsibility of local authorities.

Caring for our future 6 Key issues for reform There needs to be a clear and common understanding of what personalisation means across different settings and institutions (for commissioners, providers, the public and the regulator). The public does not have a clear understanding of what ‘the deal’ is for them – there is a lack of good quality information at both national and local levels. Systems need to be simpler and less bureaucratic, focussing on people’s outcomes. Culture and attitudes within some councils and providers remain resistant to reform Not all the building blocks are yet in place (the development of the market, brokerage and support, information, workforce). Against the background of a tight financial settlement, some people consider that personalisation is an add-on or ‘luxury’ that cannot be afforded at the present time. Some people need more support than others in managing their personal budgets. Personalisation in residential care lags some way behind community-based care. Personalisation has to pay due regard to risks to the individual and to safeguarding. Most of the ‘easy’ wins have already been made and mainstreaming personalisation across the system is particularly difficult for the next stage (older people, people with mental health issues and people who lack capacity).

Caring for our future 7 Key findings (1) We heard: Personalisation is about more than Personal Budgets – it’s about family, carer and community support. An ‘arm’s length body’ may be more acceptable for self funders than local authorities. Insufficient attention has been given to developing the market differently. Insufficient attention has been given to changing how providers deliver individuals’ outcomes, particularly in residential settings. Commissioning and contracting has been overly focused on bottom line costs rather than on outcomes and quality. Users and carers are insufficiently listened to and heard by both councils and providers and there has been insufficient development of user-led organisations. Insufficient attention has been given by councils and providers to the training of staff and carers. Personal assistants need support networks if they are not to become isolated.

Caring for our future 8 Key findings (2) We heard: Workforce issues are particularly acute in remote, rural areas. People need to have more consistent access to direct payments and personal budgets across the country and to information and advice. Don’t make giving access to direct payments the sole goal as it could lead to unintended consequences. People who are ineligible need access to prevention and signposting – a national and local offer. There needs to better measurement of outcomes. A great deal of money is wasted across the system and nobody takes corporate responsibility for this. Personalisation and safeguarding have to go hand in hand. Prevention should be a key component of personalised long-term care. Pilot direct payments for people in residential care but do not introduce all at once (insufficient clarity about what the overall impact might be).

Caring for our future 9 Opportunities Combining personal budgets with personal health budgets (and other funding streams) could lead to both improved efficiencies and improved outcomes. Councils can do more now to extend direct payments to the families of people who lack capacity. Greater support for carers can lead to better outcomes for users and carers. Councils could do more to encourage the pooling of budgets so that people’s outcomes can be maximised. Central government could do more to raise awareness of the changes to the system and encourage local authorities to respond the challenge.

Caring for our future 10 Commission on funding of care and support recommendations: key findings Views expressed were: People have not commented in great detail on the proposals as they relate to personalisation, as they are considered person-focused. Support for more local and national information to be available so that people can make informed decisions in a crisis and for those outside the system (both below the eligibility threshold and over the capital threshold). Extending direct payments to people who live in residential care would help to break down the care costs in much the same way as the Dilnot metering system would monitor individual care costs.

Caring for our future 11 Emerging priorities for action Person-centred change: not dependent on mechanisms such as personal budgets, where quality is delivered by the whole of the health and social care workforce at all levels eg a better outcomes framework, a dedicated organisation to drive forward change. Leadership is needed in developing and supporting this beyond what can be provided within local government. A universal information service: independent of local government but mandatory at a local level – signposting, service information, advice on personal budgets and personalisation more broadly. Data: judge the impact of processes by results, measure the ‘excitement of people improving their lives’. The current proposed trajectory of personal budgets is challenging and potentially unhelpful: so we need support, brokerage, training, consistently applied legislation, clarity about what a personal budget can be used for, to ensure the objective is met. Quality control: some kitemarking of services, particularly for those that would not traditionally be considered as part of ‘social care’ (the Think Local Act Personal markers are a good starting point for this, as is the Community Catalyst kitemark).