1. Homecare Europe – UK developments in homecare

2. Being in Control Current policy focuses on care directed by the people receiving the care, with responsive and flexible packages of care. Initiatives include:  Direct payments  Individual budgets  Outcome based commissioning  The “In Control” programme

3. A changed system of social care  Puts people in control of their own lives  With self-directed support  Controlling the money funding their care as much as they want  The In Control initiatives aim to change the organisation of social care so that people who need support can take more control of their own lives and as citizens.

4. This requires a cultural shift  Our systems used to put social workers and people commissioning care in the driving seat  We are now moving to making the key relationship the one between the service user and the provider

5. The changes required  For social work practitioners letting go of control  For providers moving from organisations built to carry out prescribed tasks, for agreed levels of money to ones able to take responsibility for meeting outcomes flexibly, within agreed budgets  Moving from a client-contractor relationship to genuine partnership

6. Initiatives underway  Direct payments (all authorities) – where people after assessment are given the money to pay for their own social care  Individual budgets (13 pilot authorities) – a system which streamlines assessment across agencies so that there is a transparent allocation of resource to an individual in cash or kind

7. Initiatives underway (contd).  Outcome based commissioning Change outcomes – outcomes to bring improvements in an older person’s mental and physical condition to a point where services could be reduced or withdrawn Maintenance outcomes – situations in which only slight improvement, stability or deterioration is expected – maintenance of an acceptable quality of life is the aim.

8. Outcome based commissioning  Commissioner agrees with the service user the issues to be addressed  Commissioner will decide a volume of service within which the provider should work  The provider then works directly with the service user to decide what work will be actually done.

9. Emerging themes from pilots  The importance of support of the users’ own caring networks  Access to free brokerage and professional advocates  Better information needs to be accessible  A need to change all of our systems and practices and not just the contracts for homecare  The need to change staff behaviour

10. Respecified contracts  Providers make decisions about what work will be done with service users  Providers work within an agreed budget which they can vary but not exceed  They must work with commissioners so that service users get the minimum level of service to meet the outcome  They are required to develop a workforce which is able to deliver this higher level of responsibility.

11. We are still learning about  How to make the assessment and care management functions deliver well  What skills are needed for the new way of working  How to take all parties through the cultural changes necessary to bring about real improvements in care

12. Some website addresses to follow up:  In Control www.in-control.org.uk www.in-control.org.ukwww.in-control.org.uk  Individual budgets www.csip.org.uk www.csip.org.ukwww.csip.org.uk  Outcome network www.changeagentteam.org.uk www.changeagentteam.org.uk  Direct payments – policy and guidance www.dh.gov.uk www.dh.gov.ukwww.dh.gov.uk