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Understanding outcome based support planning

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Presentation on theme: "Understanding outcome based support planning"— Presentation transcript:

1 Understanding outcome based support planning
LUCIANNE SAWYER CBE COMMUNITY CARE RESEARCH & CONSULTANCY

2 The impact of Outcomes on Support Planning
Getting support planning right Brokerage Resources – not just services Commissioning – investing not funding The market Measuring 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 outcomes What the outcomes are and what the barriers (needs) are Who will be involved and what do they will do Evidence 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 possible In some cases family or friends may be too protective Some have no capacity to plan support Some just don’t want the hassle of doing it all themselves IB pilots modelled on In Control – but LD service users likely to have previous exposure to services Those in pilots who got an IB were x 5 more likely to already be on a Direct Payment Suggestion is that people DO WANT CONTROL – want services which will respond to them flexibly want services that do the things that they know to be the right things to do things that will work – services that will be better but they don’t necessarily want to have to create those services for themselves

4 Support planning – getting it right
Starts once RAS has allocated resource Should focus on bringing about best possible levels of independence, health and well being but must also reflect each person’s own priorities Will 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 life Concerned with bringing about support which is flexible and responsive About 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 aims Ensures the outcomes are the right ones for that person These should apply to every service user, however they get funding and whether they control it themselves or not – so long as outcomes thinking permeates all our processes, and way of working So 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 Services Applies to everyone, including those who wont qualify for public funding Demands universal access to such services as transport, leisure, housing, education Early Intervention and prevention Choice and Control Social Capital Community, family and friends networks etc.

7 An outcome-based approach
CONVENTIONAL Assessor considers needs in consultation with user Assessor identifies tasks to be completed on each visit Assessor specifies time of arrival and time of departure Monitoring consists of verifying visits and checking tasks completed Success is related to efficiency in carrying out visits and tasks according to specification OUTCOME-BASED Service user identifies desired outcomes (priorities) in discussion with assessor Assessor considers needs and determines time budget and eligibility. Possibly agrees some tasks with user, but user can change these as he/she wishes Provider 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 tasks Allocated time can be used flexibly over a given period Monitoring will include verifying visits and recording tasks Success 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 mediator Should be independent of funders and providers In the social care context will provide planning supports that are flexible and are controlled by service user (and family) INTERNATIONAL CONVENTION – SAN DIEGO 2002 DH guidance Provide a range of information Undertake, or assist with, support planning Guidance on choice of support resources Negotiation, mediation Facilitation Provide or access technical skills/information Advocacy GOOD PRACTICE IN SUPPORT PLANNING AND BROKERAGE – PERSONALISATION TOOLKIT Brokerage may well be used by people who are funding their own support – signposting them to brokers, as well as providing other information and advice But also people who have funding via PBs, whether they are managing that themselves – or receiving help from family members or friends Where 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 suspect Whether or not there is a role for brokers in managing PBs, I don’t know Below 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 which Provides a long list of areas of advice which should be covered by brokers Advises on voluntary association roles in brokerage, advice etc. and importance of peer support in helping people to understand Tells 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
Advocacy BROKERAGE

10 Who provides brokerage?
Brokers must: Understand the concept and practice of outcomes working, focusing on what is most important to the person Understand local market Have wide knowledge of local and national resources, including benefits etc. Know where to access specialised advice Have ability to ‘think out of the box’ How to make best use of budget i.e. not just buying paid support Be able to design, or assist in designing and costing, support which supports the person in relation to his desired lifestyle, needs and chosen outcomes Have excellent communication skills, including how to help those with communication difficulties Have stories (examples) of how others have used budget Understand issues around capacity to consent A whole range of sources for brokers: Independent – self employed Working for local or natioanl vol. org which doesn’t supply services – potential for peer support Independent agency brokerage/advocacy Service providers Local authorities – care managers carrying out advocacy role families No 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 provision One 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 access Volunteers or voluntary sector organisations Range of specific social care services In-house provision Voluntary or private providers – commissioned or purchased individually Individually sourced Personal Assistants Tell story of SID Library, leisure centre, church or other faith organisations, transport, housing, welfare rights What 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 resource Or 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 Funder Invites submissions, often to a rigid specification, and selects from those applying Believes fairness means keeping a distance from proposers Considers grant or contract decisions the high point of the work Monitors for compliance The Investor Seeks to uncover all promising opportunities and encourages innovation Believes fairness means intense interaction with applicants Considers the initial investment only the starting point Asks: How can I help? Taken from Institute of Rensselaerville document Likely 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 service BUT 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? CHANGE Fewer prisoners re-offend – change in behaviour Reduction 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 health What is it that you are getting for your money?

14 Making the change Involve providers as you develop your ideas – get widescale commitment and provide training Really 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 initiative Relationships 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 done Of 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 to Discussing problems Joint commitment to success TRUST No blame culture Permission to do things differently Shared risk Good communication PIE IN THE SKY ?

16 Measuring outcomes Must start with baseline data Service outcomes
numbers of people able to continue living at home Individual outcomes physical 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 much did we do? How well did we do it? Is anyone better off? Quantity Quality

18 ‘hard’ and ‘soft’ outcomes
Observable functional improvements Reduction in recidivism or substance abuse Young care leavers have improved academic qualifications Carers are able to continue at work SOFT Improved quality of life Reduction in depression Carers have reduced stress levels People feeling more confident Older people feeling valued Well being Hard outcomes are much easier to measure Soft 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 groups ASCOT 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 care Determines whether the service/care package delivers the desired outcomes Understand how different features of the service impact on user/carer experience This 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 USERS Feeling safe Having things to do Seeing people Staying as well as you can be Living where you want and as you want Dealing with stigma/discrimination (mental health) FOR CARERS Quality of life for the cared-for person Maintaining health and well-being A life of his/her own Positive relationship with the person cared for Freedom from financial hardship

22 The Outcomes Star Personal responsibility accommodation Living skills
Social network employability Substance risk Health

23 Outcomes Star – type of scale
Number Indicator 1 No motivation 2 Focuses for brief periods of time only 3 Does want to change but feels helpless/powerless to do so 4 Begins to request some help 5 Wants to change and has some idea in what way 6 A clearer sense of what he or she wants and some idea of steps needed to get there 7 Active in getting closer to his or her goal, has a sense of how others see him or her 8 Noticeable change in behaviour, can evaluate options 9 More comfortable with new lifestyle 10 Feel 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 level Regularly available Statistically robust An appropriate measure of the framework outcomes Avoid perverse incentives etc. Promote improvement


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