1. North West Housing LIN meeting 3rd July 2013
Sue Garwood
Extra Care Specialist
How personalised is care and support in Housing with Care for older people?
North West Housing LIN meeting
3rd July 2013

2. Plan for this session Setting the context Sharing impressions
Discussion of the issues
Apologies from Sue for not being able to attend, and thanks to Jean, Libby and Chris for leading the session

3. Personalisation – the ethos
Holistic support tailored to the needs and aspirations of each individual
Maximising choice and control – both at individual level and group or community level
Self-directed support – The process by which personalisation put into effect ....in theory
Individual defines outcomes
Can choose who provides support
Can determine what shape that support takes
Can take as much control over support as s/he wants
Signed off by local authority
Opportunity for out-of-the-box, innovative solutions/services – dynamic process at its best
One route to enabling choice and control is personal budgets

4. Personal budgets (PBs)
Part of personalisation and self-directed support
An up-front allocation – transparency
Specified in the Care and Support Bill
Portable
Intended to have flexibility around what it can be spent on to achieve identified outcomes
Emphasis on individual choice and control – this should include how that budget is managed or deployed
Can be “managed” budgets, or direct payments
Brokerage and Individual Service Funds as a means of supporting individual to manage PBs
Personal budgets becoming the standard “currency” by which Adult Social Care authorities provide services for people who have eligible community care needs

5. Will be re-writing at the beginning of next year, but much of it still applicable

6. Care in Extra Care housing
With advent of personal budgets and austerity, the way care is procured, configured and charged for is changing
Need to retain viability and benefits of ECH while maximising choice and use of portable PBs ... arguably ECH is not ECH without 24/7 care on site
Local authorities appear to be increasingly:
Significantly reducing the size of block contracts, or
Removing block contracts altogether, and paying for those with assessed eligible needs via personal budgets, and sometimes....
only covering planned care and support, leaving schemes without 24/7 cover or leaving it to providers to develop at own risk

7. Possible models
Some overlap between them and enormous variations within them
Range from “micro-commissioning” at one end of the spectrum to “package holiday approach at the other”
Spot purchasing – p25 and case study 1, 6B
Core and add-on – p26 and case studies 1,2,3,4
Block contract all care with opt out – p28, cs 5,6A
Block contract with no opt out – p29, cs 7
Co-production – p30, cs 9
Pump-priming – p30 and cs 8
“Framework contracts” – p37 and cs 1

8. Core and add-on – gaining traction?
Bulk of the care in the form of personal budgets used for individual packages of care & support
Core (shared) service commissioned or grant aided by local authority, or delivered by provider at own risk
Variations around:
Who funds the core
Who charges for it
Whether a separate charge or part of over-arching service charge
The level of the charge and how it is decided
What services constitute the core
How generous the care element is

9. Discussion paper
Written to explore the impact of personal budgets and other changes on care provision and resident outcomes
The way in which the care in HWC is procured affects the way it is structured and delivered
That in turn can affect the quality of life and health and wellbeing outcomes for residents
Other things which appear to impact include:
Local implementation of support planning and personal budgets
Tightening budgets and amount in PBs for older people
Loss of Supporting People funding in many schemes

10. How typical or accurate are the following impressions?
A new potential “boundary” dispute between planned care and the core (wellbeing/ emergency /floating provision) seems to have resulted
Care and support delivery in HWC schemes seem to be becoming less flexible and responsive
Residents with unpredictable needs, such as those with dementia or anxiety are more likely to lose out

11. How typical or accurate are the following impressions?
The care and support plans appear no more life-enhancing, holistic, imaginative or outcome-based than they were before the advent of personalisation, while supplementary services may also have been reduced
Choice of PB deployment mechanisms is not always made available, and residents may even be unaware that they notionally have a personal budget, so the opportunities for genuine choice and control over their support plan seem limited (See Age UK reference )

12. Points for discussion
Is the core and add-on approach becoming the norm?
Was flexible and responsive care and support in HWC in the days of yore reality or illusion?
Is the care and support in HWC for older people becoming less flexible and responsive?
Are boundaries becoming more rather than less rigid?
Are care and support plans any more personalised and imaginative with the advent of “personalisation”?
Do residents have greater choice and control as a result of PBs?
Can anything be done to address these issues?
Any other trends?
Examples or case studies – whether of good or bad practice – would be much appreciated

13. References Garwood, S – Care and Support in Extra Care Housing (2010)
Garwood, S – Discussion paper: Improved personalisation in Older People’s Housing with Care? (May 2013)
Age UK - Making Managed Personal Budgets Work for Older People (April 2013)
Head, J et al – Funding Extra Care Housing (May 2013)

14. Contact details: sue@suegarwood.co.uk www.suegarwood.co.uk
Extra Care Specialist
Thank you
Contact details: