Personalisation and individual budgets: challenge or opportunity? NOVEMBER 2009 Helena Taylor Knox Key points Personalisation is here to Commissioners and stay: providers need to work together to Helena Taylor-Knox Personalisation and demonstrate a is a managing individual budgets return on investment director in her own (IBs) need to be in outcomes for partnership woven into citizens and greater consultancy, which organisational value for money. specialises in the strategy, policy and organisational procedures development arena, and Organisations need an HQN Associate. to test their systems With over 15 years' to ensure they are fit experience in social for purpose for IBs and in particular supported Organisations need housing, she is part to consider how to of HQN's mock position their inspection and services to make coaching teams. As a them attractive to business psychologist customers with IBs she has a BSc in Behavioural Joint working Sciences from opportunities should Leicester University be exploited and and a Master's in encouraged to map Mental Health wider revenue (Organisational streams to meet Psychology and support plans Psychiatry) from King's College, IBs could provide a London. powerful framework Helena completed to deliver high her clinical training in impact support and New York. resources to individuals and families in our most deprived areas 2 – Personalisation and individual budgets: challenge or opportunity? Introduction Personalisation is throughout. In the perhaps the most following pages we will significant shift in explore: transforming social care and support we have What IBs are and seen in the last three how they differ from decades. It underlines a personal budgets core principle of providing high quality individually What are the drivers tailored services which behind this cultural meet the care and shift? support needs of vulnerable adults. As a Whether IBs will concept it implies that really work services should no longer be commissioned en How commissioners masse for a specific could respond client or user group, but that the services, How providers could information and support respond. will vary greatly between individuals. Choice, independence and control are the three This paper seeks to words that have explore some of the watermarked just about implications for housing every government policy, providers and guidance note and commissioners of research commissioned supported housing. It in the last five years. As aims to provide some regulation has and challenge to the sector to continues to address the begin weaving choice, quality and monitoring of control and care and support personalisation services which people throughout our policies, receive, it has allowed a procedures and services greater emphasis on to position the sector as understanding the end- the leaders in finding user of a service as a flexible solutions for our customer who should customers who require have rights, choices and assistance, care and control over their own support. In doing so we lives. Indeed this has appreciate that readers of been enshrined in the this briefing will be at Welfare Reform Bill varying levels of both through the right to progress and control. understanding of the implications of transforming adult social care services and have tried to address this 3 – Personalisation and individual budgets: challenge or opportunity? The personalisation safeguarding, quality A lack of control for agenda represents a assurance and what the services users to major cultural shift in the move towards choice shape or change the way we commission and means for the providers way their care and plan support services. It of services. We must support was changes the climate of understand that at the delivered. services from services heart of the existing because there is personalisation agenda is This was the first time a a need, to services being a cultural shift which government review had commissioned because requires providers and fully captured the fact there is a demand. What professionals to be that until now services might this mean in the accountable to customers were provided in ways world of supported or risk losing their which were more housing? Well, let us ask business. convenient for providers how might services look rather than tailored to when sheltered residents What are the key offered quality and choice opt to buy in scheme drivers for change? to customers. manager support from another service, perhaps Green Paper on social Putting people first a private sector provider? care What about if a floating In 2007 Putting people support customer In 2005 the government’s first: a shared vision and chooses to go to the Green Paper on social commitment to voluntary sector provider care set the tone for a transforming social care, for their support, rather large step change in the the ministerial concordat than the local authority commissioning of care was published. In this in-house service which is and support. This document it was clear currently working with followed several reviews that the government had them? What happens of assessment, care recognised that despite when customers decide planning and two years of discussing to work with another commissioning the personalisation contractor and liaison arrangements which agenda, pockets of good officer on their disabled highlighted: practice were the facilities grant? These exception rather than the are all realities in the new Huge regional rule, due to a lack of a climate of self-directed variations in strategic commitment care and support. assessment/support and direction. The Home planning processes Office set out clearly this The mere mention of self- year (2009), what they directed support, IBs or Processes which believe needs to happen: personalisation has a were provider/ catalytic ability to divert commissioner- “…the social care sector conversations off into a driven rather than needs a shared vision: myriad of positives and user-led personalisation, including negatives. Few would a strategic shift towards disagree with the Lack of flexibility early intervention and principle of providing and options in the prevention, will be the people with more choice way which support cornerstone of public and control, but in recent or care could be services. 1 years we have heard provided concerns about 4 – Personalisation and individual budgets: challenge or opportunity? A transparent allocation of resources, giving individuals a clear cash or notional sum for them to use on their care or support package A streamlined assessment process across agencies, meaning less time spent giving information Bringing together a variety of streams of were left meeting the more into an hourglass support and/or needs of only those shape in reality, as funding, from more whose needs were resources at the top and than one agency ‘critical or substantial’. universal stages balloon This in turn breeds a and the squeeze on Giving individuals situation where targeted services for the ability to use the prevention slips off the communities and families budget in a way that agenda and creates a becomes ever tighter. 2 best suits their own system which becomes particular purely about responding The most recent requirements to crisis. A report by the development from Association of Directors ADASS and the Local Support from a of Social Services Government Association broker or advocate, (ADASS) and (LGA) has moved the family or friends, as Communities and Local Putting People First the individual Government (CLG) in agenda on through their desires.” 2002 identified how an letter to local authorities ideal spread of resources issued in September this What this extract should look when year. This set out a illustrates is that in commissioning services series of milestones addition to a strategic (triangle of care, below). which they will use to commitment, a shift in the When applied to reality, it inform: way resources are rapidly became referred allocated is required. to as the ‘inverted Delivery of the Under the existing triangle of care’, where Putting People First commissioning we flipped the triangle to transformation framework those show that the spread of accessing social care resources is targeted at The Transforming services were assessed the small group of those Adult Social Care against the fair access to in crisis to the detriment (TASC) programme care services criteria of others and ultimately (FACS). With dwindling left out prevention work. Care Quality local resources this often We might argue that this Commission meant that authorities is now beginning to turn judgements and 5 – Personalisation and individual budgets: challenge or opportunity? their consistent Personal budgets and Will individual budgets contribution to individual budgets really work? Comprehensive Area Assessment. Until recently it was clear As we have already that personal budgets mentioned there has The first significant have solely referred to been a mixed bag of milestone will be that by services which are positivity and scepticism 2011, 30% of people who directly procured from around the are eligible for a personal one pot of money, implementation of IBs. budget will have taken primarily health or social The University of York this up. We will provide care. These were linked Social Policy Research an overview of the other into a clear assessment Unit and the Personal milestones later in this of eligibility and usually Social Services Research briefing. service criteria such as Units of Manchester the fair access to care University, LSE and Supporting People system. This was then University of Kent, and usually managed through King’s College, London, As the second driver for one of two processes. formed in 2006 the change the introduction Either a direct payment, Individual Budgets of Supporting People where the customer Evaluation Network (SP) in 2003 brought the would assume the (IBSEN), which evaluated opportunity to create a administrative control of the first phase of 13 local framework for their allocation and authority pilots. preventative services and procure the service, or create strategic action where the choice would First, they identified the plans for support services be made by the service key stages of the process across local authority user but the care undertaken to achieve on areas and by user group. manager would retain IBs; this included: Six years on the success responsibility for and challenges of SP are procuring the services. In Stage Action well documented, but one some instances a 1 A range and of the key outcomes has combination of both scope of been a continual push to approaches were used. assessments ensure that the spread of undertaken to resources meets local IBs were created to pool identify specific needs and demands and together a personal support and a move towards resource allocation from care needs measuring the outcomes multiple funding streams. 2 Eligibility of support in terms of the So in reality this could assessments impact and improvement combine money from under the FACS to individuals lives. It adult social care budgets, system seems obvious looking SP, disabled facilities 3 Resource back, that self- directed grant, independent living allocation and care and support, IBs funds and access-to-work identifications of and personalisation was funding, to form one pot funding streams the next logical step. of cash from which to (could include procure services which SP, disabled fulfilled the personalised facilities grant, care and support plan of independent the service user. living fund, access to work, 6 – Personalisation and individual budgets: challenge or opportunity? Stage Action were four main recurrent including in staff social care) questions: training 4 Financial assessment to 1 What could/should be People using IBs ascertain legitimately paid for were more likely to individual as an IB? feel in control of contribution their lives than 5 Funding agreed 2 What equipment people receiving 6 IB signed off by could be purchased? conventional social co-ordinator/ care support care manager 3 Can/should family 7 IB implemented members be paid to Satisfaction varied with a review provide care/support? between client scheduled groups: highest (usually six to 4 Who is responsible for among mental eight weeks) resolving crisis or health service users conflicts in an IB? and physically IBSEN found that cost- disabled people, effectiveness varied As with most new and lowest among between user groups, initiatives, only after older people although the pilots had testing scenarios out over been running a relatively time will the full answer to A substantial short time before the such questions be clear. proportion of older evaluation was complete. Indeed the answer will people felt that The main outcomes vary from case to case taking control of however for users were and authority to authority. their support was a significant; including: As such the Department 'burden'. for Work and Pensions Improved health and has requested fresh Staff encountered emotional wellbeing pilots, learning from the significant barriers to first round to be integrating funding Improved quality of undertaken this year with streams. life evaluation due in summer 2010. The areas It would be useful for Making a positive they will specifically be both local authorities and contribution looking to address are providers to factor some some of the themes of these themes into their Choice and control which came out in the own planning and pilot evaluation including: evaluation of Freedom from personalisation initiatives discrimination There was little and ask: what could difference in the make it better? Economic wellbeing average costs of IBs and conventional Resources Personal dignity. 3 social care support. However, One final note from the In addition the research implementing IBs IBSEN research was the also identified a number nationwide would work they completed on of key concerns from require substantial resources and costs. This people and organisations investment, illustrated that the involved in it, but there average weekly costs of 7 – Personalisation and individual budgets: challenge or opportunity? an IB was £280. However services (see references they also identified that at end of briefing). individuals with an IB came into contact more with their local authority social worker and that support planning took significantly more time. Again this presents both an opportunity and a challenge in terms of scrutinising existing needs assessment and support planning procedures. Some organisations in the pilots had separate teams which just focussed on drawing up the support plans; others utilised existing procedures across agencies. In addition almost half of the service users in the pilots opted to have a personal assistant to help them plan, monitor and administer their IB. Provider organisations may wish to think what role they could play in supporting customers to access personal assistant-type services. In Control (a social enterprise that was set up to transform the current social care system into a system of self-directed support) has a website full of useful resources and examples of positive practice in terms of policies, procedures and tools to help organisations consider how they might integrate an IB culture into their existing 8 – Personalisation and individual budgets: challenge or opportunity? How can The starting point for any Safeguarding commissioners commissioner would be Authority to seek to identify how measures?) respond? and where they could accommodate or develop 7 How can we support the seven-stage local providers in approach identified from implementing IBs the learning during the and avoid losing pilots. This would mean valuable local looking at both in-house services? and external processes and possibly looking at In addition local multi-agency frameworks authorities will need to be and protocols which mindful of the milestones could support the move set out by ADASS this to IBs. This will include month, which they hope identifying: every council will adopt as key priorities and 1 What are the which address five funding sources strategic areas: which exist locally for care and 1 Effective support? partnerships with people using 2 What established services, carers and working other local citizens. relationships and protocols do we 2 Self-directed have in place to support and pool these funding personal budgets. streams together? 3 Prevention and 3 What gaps are there cost-effective which we need to services. bridge? 4 Information and 4 What will be the advice (access to agreed assessment and provision of). and allocation framework? 5 Local commissioning 5 How will this be (expansion of monitored and choice and the use reviewed? of the third sector). 6 What safeguarding This will be more of a arrangements will challenge for those we have in place authorities who are (how will we ensure beginning on the journey we comply with the of moving towards more new Independent self-directed systems. 9 – Personalisation and individual budgets: challenge or opportunity? The advantage, however, Children and young they work; such for such authorities is that people opportunities are well there are plenty of case worth investigation. studies from which to Special tools for learn and some useful people with We have provided below tools which have been communication the tables from ADASS tried and tested out with impairments which set out their providers. In addition we milestones for have seen some local Advocacy schemes. transforming adult social authorities launch care services, starting innovation funds and In addition there are with a target for this year special time-limited some support and to ensure that IB is well grants to pilot IB supported housing understood locally and, schemes looking at providers who work critically, that users are particular areas of cross-authority and are involved in developing concern for them for keen to share their and shaping the local example: learning and experience practice. with local authority Those with complex partners to roll out IBs in or multiple needs all the areas in which April 2010 October 2010 April 2011 Effective That a That local service That every council partnerships with communication has users understand area has at least people using been made to the the changes to one user-led services, carers public including all personal budgets organisation who is and other local current service users and that many are directly contributing citizens and to all local contributing to the to the transformation stakeholders about development of local to personal budgets. the transformation practice (by December agenda and its 2010) benefits for them That the move to personal budgets is well understood and that local service users are contributing to the development of local practice (by Dec 2009) That users and carers are involved with and regularly consulted about the councils plans for transformation of adult and social care 10 – Personalisation and individual budgets: challenge or opportunity? April 2010 October 2010 April 2011 Self-directed That every council That all new service That at least 30% of support and has introduced users/carers (with eligible service personal budgets personal budgets, assessed need for users/carers have a which are being used ongoing support) are personal budget by existing or new offered a personal service users/carers budget That all service users whose care plans are subject to review are offered a personal budget Prevention and That every council That processes are That there is cost-effective has as clear strategy, in place to monitor evidence that services jointly with health, for across the whole cashable savings how it will shift some system the impact of have been released investment from this shift in as a result of the reactive provision investment towards preventative towards preventative preventative and strategies and that and enabling services. overall social care enabling/rehabilitative This will enable has delivered a interventions for efficiency gains to minimum of 3% 2010/11. Agreements be captured and cashable savings should be in place factored into joint with health to share investment planning, There should also the risks and benefits especially with be evidence that to the ‘whole system’ health joint planning has been able to apportion costs and benefits across the ‘whole system’ Information and That every council That the council has That the public are advice has a strategy in put in place informed about place to create arrangements for where they can go universal information universal access to to get the best and advice services information and information and advice advice about their care and support needs Local That councils and That providers and That stakeholders commissioning PCTs have third sector are clear on the commissioning organisations are impact that strategies that clear on how they purchasing by address the future can respond to the individuals, both needs of their local needs of people publicly (personal population and have using personal budgets) and been subject to budgets privately funded, will development with all have on the stakeholders An increase in the procurement of especially service range of service councils and PCTs 11 – Personalisation and individual budgets: challenge or opportunity? April 2010 October 2010 April 2011 users and carers; choice is evident in such a way that providers and third will guarantee the sector organisations That councils have right kind of supply in their areas clear plans to services to meet regarding the local care and These commissioning required balance of support needs strategies take investment to deliver account of the the transformation priorities identified agenda through their JSNAs 4 In March this year ADASS conducted a survey of its members and in terms of progress on self-directed support it found that councils ranged from ‘substantial progress’ to those who were just beginning the change management process to personalisation. There may be significant opportunities for cross- fertilisation of learning between authorities to build on the successes and learn from the pitfalls. 12 – Personalisation and individual budgets: challenge or opportunity? How can housing Analyse what you have accepting their providers make the or could develop lifestyle choices? most of First of all we would 5 Are we prepared to opportunities? encourage providers to lose business if we really scrutinise their are not able to offer existing services and ask and support self- themselves our top five directed support and questions: care? 1 What services could These questions should we provide directly then be explored with to customers your local authority through an partners in adult social individual budget? care, Supporting People, service users and third Support services sector colleagues. The government has made Personal assistant clear its intentions for support providers to work more closely with third sector Handy person colleagues to reduce services duplication of resources and ensure that care and Social support is delivered in a support/inclusion way which supports officers choice and diversity within services and local IB admin service communities. There is also merit to exploring Support planning wider partnership working team. arrangements looking at different funding streams. 2 How would our For example could the systems and support planning processes cope with mechanism include administering these personal safety advice budgets? supported by the police, or fire safety 3 How robust and assessments funded by outcomes-focussed the fire service? Are are our tools and there any joint health systems in support initiatives? Could the planning? support planners be trained as trusted 4 How innovative are assessors for aids and we in identifying the adaptations? The scope true wishes and for innovation and cross- aspirations of our agency working is vast customers and when it comes to IB. 13 – Personalisation and individual budgets: challenge or opportunity? The support plan What this illustrates is and what ‘society’ should that having some key be paying for. To ignore This is the second key to questions at the heart of this reality in staff training effective IBs being the process such as: will result in poor support implemented. For some What are the real goals planning. We have to time both SP and the for this person? What understand that for some Audit Commission, matters? What needs to people a trip to the through the KLOEs, have change? How can the cinema, a football match been trying to get person keep in control? or a weekend art class providers to move And what needs to will mean more for their towards understanding change to make all this self-esteem and sense of and demonstrating happen? Are essentially belonging and inclusion outcomes of support. the same good practice than two hours of This is moving away from methodology you would cleaning per week. Or the ‘tick box’ method of hope to see in any that for an older person a completing lengthy and sustainable business handyperson putting up standardised form and plan. their family photos on the really getting to grips with wall is more important to support planning as a This also needs some making them feel at process. reality checking with staff home than attending the in terms of our own day centre this week. The following diagram by motivation and values. This is not to suggest that The Grove Consultants There has been some we don’t empower people and Helen Sanderson interesting media to evaluate risk, rather Associates gives a good coverage of IBs which we take a person- pictorial view of the sensationalises the focussed approach to support planning classic dilemma between understanding how an process. 5 what a person might feel individual’s resources promotes their wellbeing could be managed to 14 – Personalisation and individual budgets: challenge or opportunity? meet their needs as a person. This means supporting individuals to ask: What do I need to have to keep me healthy, safe and secure in my home and community? What would improve my wellbeing/self- esteem and confidence? What could I do differently to help me achieve some of my longer-term ambitions? Who is providing the right services for the right cost in my community to help me create the right support plan through an IB? 15 – Personalisation and individual budgets: challenge or opportunity? What else should Housing providers should Developing ways to good supported be working closely with respond to their local authority personalisation housing providers partners and voluntary through specialist be doing? sector agencies to housing – it is understand what IB will possible to develop mean locally or a core service offer regionally. Who is leading and a menu of on the initiative? Are options available for there any pilots purchase either as operating? It may take a individuals or jointly while to fully embed IBs, but the reality is that the Local authorities offer of choice, control can include and personalisation they Supporting People offer to customers is so money in the much greater, IBs are personal budget of here to stay. The Social people using Care Institute for services if Excellence (SCIE) says applicable that personalisation for housing providers Ensuring that means: people have access to information and Tailoring support to advice to make people’s individual good decisions needs to enable about their care and them to live full, support independent lives Finding new Housing and the collaborative ways local environment of working that can make a critical support people to difference to actively engage in someone’s ability to the design, delivery live independently and evaluation of services Housing providers need to be able to Developing systems offer people a and processes to choice in how and enable staff to work where they could in creative, person- live and to ensure centred ways. 6 that homes are well designed, flexible The potential for and accessible – the providers in getting this Lifetime Homes right could deliver design standards significant results in can help with this terms of successful and sustainable tenancies and new business. This 16 – Personalisation and individual budgets: challenge or opportunity? has been captured within one service, agency, or the government’s Think activity will make us Family agenda. In Think healthier, happier or Family in 2007 the more engaged with our government published its communities: it is the aspirations: “A vision for integration of many a local system that aspects of our own improves the life chances personal motivations, our of families at risk and abilities and helps to break the cycle circumstances which of disadvantage”. This is need to be understood to where we might argue inform what each of us housing providers have needs to achieve the greater opportunities independent, to impact on and empowerment choice influence service delivery and control in our lives. by looking at individual budgets within ‘‘Personal budgets and households to maximise self-directed services the impact of resources mobilise the intelligence on families and of thousands of people to communities. Perhaps a get better outcomes for housing standard should themselves and more be ‘Think Household’. value for public money.’’ 7 Combining the ‘think household’ model with an integrated approach to IBs, mapping and delivering resources and opportunities for some of our most vulnerable customers in our most deprived area suddenly becomes an exciting challenge and a realistic opportunity. The personalisation agenda represents an opportunity to understand and respond to what matters most to our customers and communities in a way that we never have had before. The cautionary note is that this will not work if organisations stand alone. The best examples of joint working have evidenced that, no 17 – Personalisation and individual budgets: challenge or opportunity? And finally, what The future political continued fair and full about the politics? climate is uncertain in implementation of the terms of a real personalisation agenda. commitment to self- The challenge for directed care and commissioners and support. Whilst, as we providers is to work said at the beginning of together in the this briefing, no one could implementation of IBs argue with the principles and carefully monitor and behind personalisation, evidence the outcomes the scope to which this is and impact on the lives of evidenced could be up local citizens and for debate. Already with budgets to demonstrate a discrepancies amongst return on investment of local authorities’ progress the approach and in the on the matter, we have to quality of lives for local question just how high residents. IBs are in the strategic priorities ‘to do’ list. With predictions of large scale public spending cuts and the uncertainty around changes in government, it might be tempting for politicians and commissioners to focus on things which appear to be ‘essential’ care and support services, rather than those which could be deemed as leisurely pursuits. The danger in this is that it could undermine entirely the very real links between choice, control and wellbeing for many people who require care and support and neglect things which are truly preventative. We are hopeful that the fact that the move towards greater personalisation of services and individual budgets has received high profile debate time in both houses of Parliament this year will signify a cross-party commitment to the 18 – Personalisation and individual budgets: challenge or opportunity? References Association of Directors of Social Services and the Local Government Association (2002) All our tomorrows. Essex County Council: Support Planning Policy. Leadbeater, C, Bartlett J, Gallagher N: Making it Personal 2008 demos. Social Care Excellence Institute 2009 At a glance 8: Personalisation briefing: Implications for housing providers. 19 – Personalisation and individual budgets: challenge or opportunity? Website references http://www.dhcarenetwor ks.org.uk/ http://www.in- control.org.uk/ http://www.in- control.org.uk/site/INCO/ Templates/General.aspx ?pageid=1056&cc=GB 1 Home Office: Jan 2009 2 All our tomorrows 2002 3 Consultation on Independence, well-being and choice, Department of Health, 2008: http://www.dh.gov.uk/en/C onsultations/Closedconsult ations/DH_4116631 4 ADASS September 2009 5 Essex County Council support planning policy 6 SCIE 2009 7 Leadbeater et al 2008 20 – Personalisation and individual budgets: challenge or opportunity?