So what? Implications from the National Evaluation Presentation for RiPFA

Implications  Risk and Safeguarding  Personalisation in rural areas  Impact on providers and commissioning  Overall implications

Safeguarding and Risk...We found  Parallel tracks – little engagement of the IB pilots with adult safeguarding  Little building on adult safeguarding experiences among social workers  This reflected some uncertainties around Direct Payments etc & duties of care  Fears that raising safeguarding issues was at best reactionary, at worst subversive

What can be done?  Converging of systems  Mutual understanding of values  Skills sharing between safeguarding and self-directed support  No quick solutions or transfers (eg a Risk Enablement Panel)  Meaningful practice guidance  Revised policy and procedures

What aspects of safeguarding do we need to build into personalisation?  Not a bolt on  Risk and recording  Finance is a fear  Don’t neglect neglect  Addressing carer issues (see Cooper et al BMJ 2009)

What training, risk assessment and risk management should we use?  Training (actually skills development) is not the same as information  An adult learning approach  Ensure legalities are addressed  Embed  Multi-agency  Local context  Evaluate

What more needs to be done?  So this means monitoring? (how and who? And who pays?)  Role of new regulator? (Care Quality Commission) and GSCC?  Bricks without straw (yes, we mean resources)  Will debates surface about rights of entry/intervention? (the Scottish experiment)

What aspects of personalisation can we build into safeguarding?  What links a support plan with a safeguarding plan?  What links a best interests decision with a right to risk?  Who will stand up ‘come the inquiry’?  How are outcomes for people who are vulnerable built into safeguarding investigations?

How do we better reflect service users’ informed choices?  Recording (being clear)  on paper? on video?  use of advance decision making processes?  Best interests debates  Learning from Independent Mental Capacity Advocates and Independent Mental Health Advocates  Duties of care

How can we move forward on this agenda?’  Not just a council affair  Nor even statutory sector  Way of revitalising adult safeguarding  But there will be decisions about monitoring (over and under protection)  And the safety net of social care may be tested.

Obstacles  Increased risk  Increased costs  Individualised services  Usual rural issues (eg transport)  Continuation of mainstream services  What happens to those not wishing to take up IBs  Availability of services and workers in rural areas Source CRC research interviews

Implementation issues  Good contingency planning  Focus on monitoring  Paying for transport costs and staff time  Information and advice about advocacy schemes, practical services and charges  Careful preparation to support people to engage in the new support planning processes  Workforce development Source CRC research interviews

The challenges for providers  Rostering  Recruitment and retention of staff  Losing staff to PA opportunities  But more rewarding job?  Training  Risk management  Harder to plan ahead  Invoicing and non-payment

New commissioning roles for local authorities  Informing the market – both supply and demand  Supporting providers through change  Promoting standards  Managing tensions efficiency vs personalisation

Can IBs remain cost-neutral?  Allocating resources – underlying principles  Integrating funding streams  ILF review  Increased demand for IBs  Mental health services  Managing the ‘winners and losers’  From bulk purchase to individual buyers

Practice issues  Managing change  Information  Training  Champions  Involve stakeholders  Managing risk  New ways of deploying IBs  Spread understanding of different approaches  Managing finance arrangements  New roles for social workers/care coordinators

Issues for policy  Resource allocation – underlying principles  Funding streams – personal budgets (social care only)  FACS and charging policies  Individualism over collectivism  The legitimate ‘boundaries’ of adult social care

Conclusion  IBs – developing example of personalisation  Suggested positive outcomes  Identified areas of concern  Managing change  Integrating safeguarding  Balancing individualism and collectivsim

Contact details Martin Stevens Social Care Workforce Research Unit King's College London Strand London WC2R 2LS