Presentation on theme: "Understanding outcome based support planning"— Presentation transcript:
1 Understanding outcome based support planning LUCIANNE SAWYER CBECOMMUNITY CARE RESEARCH & CONSULTANCY
2 The impact of Outcomes on Support Planning Getting support planning rightBrokerageResources – not just servicesCommissioning – investing not fundingThe marketMeasuring outcomes
3 Aims of support planning – how do we get it right? Is the ‘means by which information is presented to release funding’ (DH) but it’s a whole lot more than that as well –Sets out how to achieve the desired outcomesWhat the outcomes are and what the barriers (needs) areWho will be involved and what do they will doEvidence that DH guidance (personalisation toolkit etc) will work well for the most able and most keen to manage things themselves – but what about least able?Some have little idea about what might be possibleIn some cases family or friends may be too protectiveSome have no capacity to plan supportSome just don’t want the hassle of doing it all themselvesIB pilots modelled on In Control – but LD service users likely to have previous exposure to servicesThose in pilots who got an IB were x 5 more likely to already be on a Direct PaymentSuggestion is that people DO WANT CONTROL – want services which will respond to them flexiblywant services that do the things that they know to be the right things to dothings that will work – services that will be betterbut they don’t necessarily want to have to create those services for themselves
4 Support planning – getting it right Starts once RAS has allocated resourceShould focus on bringing about best possible levels of independence, health and well being but must also reflect each person’s own prioritiesWill providing assistance solve the problem? How can we be sure that ‘assistance’ doesn’t skew the person’s own wishes?How can we achieve the right balance of power between service user and the council?How can we ensure that even the least able can gain choice and control?In time, will everyone want to do it for themselves??Evidence from the IB pilots – comparing people with DPs who managed their own support plan – with people whose PB was managed (and 73% of those who helped manage PBs were from local authorities (care managers etc.)MANAGED BUDGETS - PA – 47% Agency home care – 30% In-house home care – 9%DIRECT PAYMENTS PA – 64% Agency homecare – 18% In-house homecare – 2%
5 Support planning – getting it right An outcomes approach can help:All about the impact that interventions have on a person’s quality of lifeConcerned with bringing about support which is flexible and responsiveAbout the person being in control, whether support is via mainstream services or unique to them – but within a framework in which there is shared agreement about the aimsEnsures the outcomes are the right ones for that personThese should apply to every service user, however they get funding and whether they control it themselvesor not – so long as outcomes thinking permeates all our processes, and way of workingSo outcomes practice can help us to get support planning, and the impact of support planning, right for individuals – and right for Councils
6 Personalisation – key areas of focus for Councils Universal ServicesApplies to everyone, including those who wont qualify for public fundingDemands universal access to such services as transport, leisure, housing, educationEarly Intervention and preventionChoice and ControlSocial CapitalCommunity, family and friends networks etc.
7 An outcome-based approach CONVENTIONALAssessor considers needs in consultation with userAssessor identifies tasks to be completed on each visitAssessor specifies time of arrival and time of departureMonitoring consists of verifying visits and checking tasks completedSuccess is related to efficiency in carrying out visits and tasks according to specificationOUTCOME-BASEDService user identifies desired outcomes (priorities) in discussion with assessorAssessor considers needs and determines time budget and eligibility. Possibly agrees some tasks with user, but user can change these as he/she wishesProvider agrees service plan with user, including times/ days of visits, and tasks – focusing on how best to achieve outcomes. User and provider can agree changes in visit days, times and tasksAllocated time can be used flexibly over a given periodMonitoring will include verifying visits and recording tasksSuccess is judged on whether or not outcomes are achieved
8 Brokerage - role Conventional role of brokerage: DH guidance Identify appropriate choice(s)Act as a mediatorShould be independent of funders and providersIn the social care context will provide planning supports that are flexible and are controlled by service user (and family)INTERNATIONAL CONVENTION – SAN DIEGO 2002DH guidanceProvide a range of informationUndertake, or assist with, support planningGuidance on choice of support resourcesNegotiation, mediationFacilitationProvide or access technical skills/informationAdvocacyGOOD PRACTICE IN SUPPORT PLANNING AND BROKERAGE –PERSONALISATION TOOLKITBrokerage may well be used by people who are funding their own support – signposting them to brokers, as well as providing other information and adviceBut also people who have funding via PBs, whether they are managing that themselves – or receiving help from family members or friendsWhere help in managing the budget is being provided by the Council, or by providers, or by some form of support/advocacy group – they are much less likely to use brokerage I suspectWhether or not there is a role for brokers in managing PBs, I don’t knowBelow is the approach suggested by the Personalisation Toolkit. It is much more engaged and is not much bothered about being independent and (perhaps) more objective SEE IB REPORT in whichProvides a long list of areas of advice which should be covered by brokersAdvises on voluntary association roles in brokerage, advice etc. and importance of peer support in helping people to understandTells us that for brokerage to be effective it is important that it constantly promotes the control by an individual of their own life and that ‘all interventions should seek to encourage and give people the opportunity to learn how to do things for themselves’That last bit makes me uneasy – what about you?Brokers, of course, may well help in the development of support plans – how does the assessment process fit with this? i.e. would a broker only be involved if the individual had done his own assessment, or
9 Brokerage An overlap but a succinct role Information Support BROKERAGE AdvocacyBROKERAGE
10 Who provides brokerage? Brokers must:Understand the concept and practice of outcomes working, focusing on what is most important to the personUnderstand local marketHave wide knowledge of local and national resources, including benefits etc.Know where to access specialised adviceHave ability to ‘think out of the box’How to make best use of budget i.e. not just buying paid supportBe able to design, or assist in designing and costing, support which supports the person in relation to his desired lifestyle, needs and chosen outcomesHave excellent communication skills, including how to help those with communication difficultiesHave stories (examples) of how others have used budgetUnderstand issues around capacity to consentA whole range of sources for brokers:Independent – self employedWorking for local or natioanl vol. org which doesn’t supply services – potential for peer supportIndependent agency brokerage/advocacyService providersLocal authorities – care managers carrying out advocacy rolefamiliesNo question here of the need for brokers to be independent of funders and independent of service providers – what do you think about that?Evidence from IBs that where local authorities managed people’s budgets there was a much greater likelihood that they would have conventional home care provision, and even of having in-house provisionOne concern: FACILITATION - according to toolkit this means ‘CONSTANTLY PROMOTING THE CONTROL BY INDIVIDUALS OF THEIR OWN LIVES – AND THAT ALL INTERVENTIONS SHOULD SEEK TO ENCOURAGE AND GIVE PEOPLE THE OPPORTUNITY TO LEARN HOW TO DO THINGS FOR THEMSELVES I am uneasy with this – what happened to maintenance and process outcomes? Is it likely to end in dictating (or even worse, only agreeing Support Plans where the outcomes are explicitly about regaining independence?)
11 Resources Support resources – not just services Family and friends Community resources to which we should all have accessVolunteers or voluntary sector organisationsRange of specific social care servicesIn-house provisionVoluntary or private providers – commissioned or purchased individuallyIndividually sourced Personal AssistantsTell story of SIDLibrary, leisure centre, church or other faith organisations, transport, housing, welfare rightsWhat about other things that we might all buy if we needed them – a taxi service, an ironing/laundry service etc.May be about signposting people to appropriate resourceOr may be about reabling person and then establishing contact with volunteer who can support outcome which is about the person’s wish to continue community participation in some way
12 Commissioners need to be investors, rather than funders The FunderInvites submissions, often to a rigid specification, and selects from those applyingBelieves fairness means keeping a distance from proposersConsiders grant or contract decisions the high point of the workMonitors for complianceThe InvestorSeeks to uncover all promising opportunities and encourages innovationBelieves fairness means intense interaction with applicantsConsiders the initial investment only the starting pointAsks: How can I help?Taken from Institute of Rensselaerville documentLikely to be fewer commissioned services – at least in terms of big contracts because:Services commissioned like this arre usually more standardised, less individual(b) If service provision is done on the basis of large contracts there is going to be little choice for service users in terms of who provides their serviceBUT THERE WILL STILL BE SOME COMMISSIONED SERVICES – what difference does an outcomes way of thinking make?This is saying that if you are an investor you will have a very different kind of relationship with potential providers
13 Commissioning for outcomes What is the return on your investment?CHANGEFewer prisoners re-offend – change in behaviourReduction in the numbers of depressed older people – change in well-being (feelings, attitudes, circumstances)More older people remaining independent – changes in mobility, confidence etc.Improved mortality rates after heart attacks – change in healthWhat is it that you are getting for your money?
14 Making the changeInvolve providers as you develop your ideas – get widescale commitment and provide trainingReally get to know your local providers – what area do they cover, what is their capacity, who are the middle managers, how open are they to change?Be clear about what you want and expect, but be open to negotiation – what are the problems they foresee in changing what they do and how they do it? How can you help them?There are advantages to them as well – staff turnover improves with outcomes working, the potential for learning new skills, and taking more initiativeRelationships with service users will also improve as providers are able to respond more flexibly and as the service user has control over what is done and what is not doneOf course this is not just providers with whom you think you may commission a service, but also providers you may want to purchase from on a spot basis, or whom you see as being a resource for people with a personal budget or their own funding.
15 Joint commitment to success AIM AT:Open toDiscussing problemsJoint commitment to successTRUSTNo blameculturePermission to do things differentlyShared riskGood communicationPIE IN THE SKY ?
16 Measuring outcomes Must start with baseline data Service outcomes numbers of people able to continue living at homeIndividual outcomesphysical or emotional (confidence, engagement etc.)Individual outcomes – simple recording or more complex tools e.g. depression index, quality of life measure
17 Results Based Accountability approach to measuring outcomes How muchdid we do?How welldid we do it?Is anyone better off?Quantity Quality
18 ‘hard’ and ‘soft’ outcomes Observable functional improvementsReduction in recidivism or substance abuseYoung care leavers have improved academic qualificationsCarers are able to continue at workSOFTImproved quality of lifeReduction in depressionCarers have reduced stress levelsPeople feeling more confidentOlder people feeling valuedWell beingHard outcomes are much easier to measureSoft outcomes present the most difficulty
19 Tools for measuring outcomes Scales based on Activities of Daily Living (ADLs) – focus on dependency eg bathing, dressing, continence etc.Instrumental ADLs include core activities of independent living eg preparing meals, doing housework, managing finances, remembering to take medication etc.A number of QOL surveys being developed – Office for Nat. Statistics leading the Quality Management Framework QMF. Within team PSSRU developing ASCOT which measures value of some social care services – seeks to identify specific aspects of people’s lives addressed by social care interventions – applicable across all user groupsASCOT was used in the IB pilot evaluation
20 User Defined Service Evaluation Tool (UDSET) Investigates users’ or carers’ experience of a service or package of careDetermines whether the service/care package delivers the desired outcomesUnderstand how different features of the service impact on user/carer experienceThis has just been re-christened, but I cant remember the new name. Its being developed at one of the universities in Scotland
21 UDSET outcomes for Quality of Life FOR SERVICE USERSFeeling safeHaving things to doSeeing peopleStaying as well as you can beLiving where you want and as you wantDealing with stigma/discrimination (mental health)FOR CARERSQuality of life for the cared-for personMaintaining health and well-beingA life of his/her ownPositive relationship with the person cared forFreedom from financial hardship
22 The Outcomes Star Personal responsibility accommodation Living skills Social networkemployabilitySubstance riskHealth
23 Outcomes Star – type of scale NumberIndicator1No motivation2Focuses for brief periods of time only3Does want to change but feels helpless/powerless to do so4Begins to request some help5Wants to change and has some idea in what way6A clearer sense of what he or she wants and some idea of steps needed to get there7Active in getting closer to his or her goal, has a sense of how others see him or her8Noticeable change in behaviour, can evaluate options9More comfortable with new lifestyle10Feel he or she is in right situation/place for forseable future
24 Data for measuring outcomes DH recommends:Should be available at PCT and/or local authority levelRegularly availableStatistically robustAn appropriate measure of the framework outcomesAvoid perverse incentives etc.Promote improvement