1. OUTCOME BASED COMMISSIONING IN THURROCK Thurrock is pursuing outcome based commissioning as a way of ensuring that the benefits of personalisation are experienced by all Strategies that give people money up front – Direct Payments and Individual Budgets – clearly work very well for people who are able to take the money and create their own support systems. However, the evidence is that most people will want to continue to use mainstream services Therefore the challenge is how to help mainstream services develop in ways that will deliver on personalisation – that is, services that are flexible and responsive every day. We believe that commissioning services by outcomes, and not by tasks, is the key to bringing this change about

2. LEVELS OF FINANCIAL AUTONOMY Individual budgets Council commissioned services People who want to have the cash and directly employ/contract People who want to choose their service, but not employ/contract People who want services provided, but want control over what they do Direct Payments Outcomes are key to all levels of financial control Focussing on outcomes at all levels will ensure that all service users have a higher level of experience

3. THE CHANGE PROCESS The changes required are wide ranging and significant They involve changes to practice, process, systems and above all culture They involve changes for commissioners, providers and service users, and a significant shift in the relationships between them

4. THE CHANGING RELATIONSHIPS BETWEEN SERVICE USER, COMMISSIONER AND PROVIDER Commissioner Commissions services to deliver tasks that address eligible needs Provider Delivers commissioned tasks Service user Receives commissioned tasks Linear and hierarchical Service user Identifies issues, outcomes and how best to achieve them Commissioner Supports SU to identify outcomes & agree resources Provider Works with SU to agree tasks that achieve outcomes Dynamic three way relationship TASK BASED COMMISSIONING OUTCOME BASED COMMISSIONING Requires inflexibility Requires flexibility

5. THE COMMISSIONING AGENDA - STRATGEGIC The process applies to all providers, but we have focussed on home care provision at this stage. We created a new Specification that emphasised; –A requirement to satisfy the commissioned outcomes for individual –A requirement to work flexibly within an overall aggregated monthly budget, committing resources where they are required We re-tendered, went from 9 to 4 providers, and chose providers who we believed would want to come with us on the journey

6. THE COMMISSIONING AGENDA - INVIDUDUAL We have moved from having Care Plans to Commissioning Plans Instead of prescribing tasks, we agree the outcome and an indicative monthly level of resource This started last October – 37% of people now have Commissioning Plans

7. THE COMMISSIONING AGENDA - INDIVIDUAL However, we believe that more is required. In particular, we believe the assessment process has to become not just outcome focussed, but person directed This is because that’s where the best identification of outcomes comes from and where the greatest degree of ownership comes from

8. PERSON DIRECTED SUPPORT PLANNING Thinking Process* Independent Support to frame the thinking Support to develop the thinking Description of situation Support Plan Service user Family and friends Health and Care services Universal services Contributions Community Commissioning Plan Resource allocation Test of fitness for purpose** Services commissioned Review of outcomes * The thinking process replaces the process of the practitioner gathering information in order to form a view and is based on the service users thoughts ** A Support Plan is fit for purpose if it will lead to the best levels of independence, health and well being

9. THE PERFORMANCE AGENDA Our overall targets are; Be in the top 10% of Councils for overall satisfaction with social care (new National Indicator) –Be in the bottom 10% for spend per head on social care We believe that effectively working to outcomes eliminates waste of resources and maximises value for money

10. THE PERFORMANCE AGENDA AIMPERFORMANCE INDICATORDATA SOURCE THRESHOLDS Providers achieve the commissioned outcomes Service users report of extent outcome achieved Care Commissioner review 1 – Above 90% 2- 80-90% 3- below 80% Care Commissioners report of extent outcome achieved Care Commissioner review 1 – Above 90% 2- 80-90% 3- below 80% The provider is accountable to the service over way support is delivered Service users report that provider has found out what tasks they think should be carried out and how Monitoring Officer – 50% sample 1 – Above 90% 2- 80-90% 3- below 80% Service user reports that the provider carries out agreed tasks – LAA specific target of 75% Service user reports that the provider carries out the tasks in the way agreed Service user reports that the provider agrees changes as and when circumstances change

11. CURRENT CHALLENGES The providers are each grappling with how to organise their workers to achieve higher levels of flexibility; Patch based, team working Pilot of service users who work as a co-operative, pooling their monthly budget of hours We are working out how to move to payment of providers by commissioned hours (outcomes) and not by actual delivery of hours. Use of electronic monitoring to ensure that, as flexibility increases, service users only pay for what they get (although this data will not be used for the invoicing process)

12. CURRENT CHALLENGES We are working out how to structure incentive payments for providers; –For achievement of user satisfaction (LAA target) –For achievement of reduced admission to residential care Restructuring of the field work services around new practice requirements, new roles and job profiles to support person directed working

13. FUTURE CHALLENGES Will providers need to diversify in order to have more and different resources to achieve meeting outcomes The independent sector is still under resourced – unit costs some 40% below Council provision. How much is this about efficiency and how much is it about quality?

14. SO IS IT WORKING Both our own internal monitoring and some providers own monitoring is showing a small increase in user satisfaction. At this stage, we are very pleased with that. We will be more satisfied with all being a little happier than just a few being much happier Our providers say that working in Thurrock is good and positive experience. We see them being innovative and confident Our field workers, despite the changes and threats to their roles, report that Thurrock is a good and exciting place to work

15. THE FUTURE The challenge for Thurrock is to keep working on the developments in both the commissioning and providing arms. It will take a few more years for the strategy to fully mature. We await the report of the national pilot on Individual Budgets. If a way is found to provide money up front without taking undue financial risks, Thurrock will have no problem in building this into its outcome based processes.