Insert Local Authority Transformation Strategy Workshop Insert date This document is part of the personalisation toolkit www.dhcarenetworks.org.uk/personalisation

Introductions Your name and role Your current level of knowledge of the transformation agenda and self directed support

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

Objectives Gain a shared understanding of the transformation agenda Agree what transformation means for INSERT LOCAL AUTHORITY Plan what work needs to be done when Agree how to approach a pilot

Transformation agenda- What’s it all about? Universal services – Adult social care must provide support for all adults with social care needs and their carers, including signposting and help in accessing a range of services that are available to all including services outside of adult social care such as transport, leisure, health and education. Social capital – developing the community and encouraging individuals to make use of all resources available to them in the community, including personal networks (family and friends), community groups, the voluntary sector and other informal support Prevention and early intervention Helping people maintain good health and independence with low level support. Identifying people at risk of losing independence and giving them support early. Helping people get back on their feet after illness, for example through “enablement”. Choice and control – ensuring people have greater choice and control over their lives, including through self-directed support. 5

Prevention and Intervention have a vital role There are activities at every stage which can improve quality of life and reduce demand Citizenship Information Lifestyle Practical support Early intervention Enablement Crisis / flexible response Institutional avoidance Timely discharge Low to moderate needs General population Complex needs Substantial needs

Benefits of transformation Benefits for users – Increased choice and control – A shift in power from the council to the individual – Greater flexibility – Prevention and early intervention improves quality of life Benefits for councils: – Increased transparency of resources and budgets – Greater flexibility and equity in provision across all adult groups – Greater awareness of support networks that exist in the community – More efficient process ‘Putting People First isn’t just a vision for social care. It demands that all parts of local government ask some fundamental questions about the types of communities they want to build’ Phil Hope, Minister for Care Services, 2009

Co-production Co-production is a key part of this agenda Real change can only happen by engaging users and carers throughout Personalisation means empowering people to develop solutions that work for them Putting People First… “seeks to be the first public service reform programme which is co-produced, co-developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services and to win the hearts and minds of all stakeholders’, especially front line staff” 8

No longer IF but HOW ‘Transforming social care’ makes it clear that all local authorities have to change their social care model and that this will involve a significant amount of work. “We have a long way to go to give everyone more choice and control over the care and support they receive. Local councils are clearly working hard to transform their systems to do this. We need to work together with local communities to ensure this progress continues.” Phil Hope, Minister for Care Services, May 2009 9

No longer WHEN but NOW Councils and partners are working to deliver significant progress by 2011. “The information given to us from councils indicates very strong progress amongst a number of councils. We are confident that this will become widespread over the coming year” Jeff Jerome, National Director for social care transformation, May 2009 10

IBSEN report The IBSEN review of the individual budgets pilots was published in November 2008, with a carers evaluation published later. The key findings included: More people felt in control of their lives More people taking up direct payments Many people continued to use mainstream services - Need for better access to support planning and brokerage Mixed evidence about the early outcomes for some people Some challenges about making it work for some groups (such as older people) - Mostly positive results for family carers 11

Transformation framework: summary Phase 1 Switch On Full Potential Investigation Blueprint (Enhance) Investigation Blueprint (Review) Blueprint (Develop) Implementation Planning Implementation Planning Implementation Planning Implementation Implementation Implementation Monitor & Sustain Limited Launch Expanding the new approach to all Optimising the systems

Personalisation – what the words mean

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

What counts as a success? Success is about service wide transformation - offering a personal budget or increasing direct payments is not enough, but is a key step The principle is to offer maximum control and choice while effectively managing risk The development of universal services and social capital have an important role to play Co-production is a key tool in transformation Reducing demand on services through a combination of prevention and early intervention.

Defining success for INSERT LOCAL AUTHORITY What elements constitute successful implementation of transformation? Which of these can we measure? Can we define success in one sentence? When can we describe transformation as “mainstreamed”?

You need to define what success means in your area Various perceptions of success Genuine choice and control? Increased Social Capital? Maintain/ improve CQC rating? Improve-ment in outcomes? Greater control over limited finances? Efficiency? Inclusion of more funding streams? A new ‘agreement’ with citizens? Avoiding bad press? More Co-production? Evidence of new options in the market? Less reliance on local authority? Demon-strable culture change? Everyone acting as self-funders? You need to define what success means in your area

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

The Customer Journey Early intervention Self-directed support Universal services and early intervention initial contact assessment - advice and signposting Meet immediate needs and enable Assess Calculate initial personal budget Support plan Authorise & validate Go live Monitor & review Early intervention This is the revised customer journey. It differs from the existing Customer Journey in the following ways: It includes Universal Services and Early Intervention Initial contact assessment is now ‘First Contact – advice and signposting’ There is a new ‘Meet immediate needs and enable’ step It reflects the features of the existing customer journey but also reflect universal services and early intervention, the meeting of immediate needs and enablement. The lighter coloured segments of the journey show the activities that take place once an individual is in the realm of social care and moving toward a support plan, whilst the darker segments show the broader activities that do not necessarily lead to a support plan and may help prevent one being required. It is also important to note that whilst the diagram shows a linear process, successful early intervention, universal services and enablement mean that for many people their journey will be slowed or even halted, and in some cases enablement may take people out of the process altogether. Self-directed support 19

How can you help customers stay independent? Those not eligible for a package can get further information Review may suggest enablement Universal services and early intervention First contact - advice and signposting Meet immediate needs and enable Assess Calculate initial personal budget Support plan Authorise & validate Go live Monitor & review The first slide showed in a simple and straightforward manner the customer journey. This is a very useful way of helping people to understand the key elements and the order in which they fall. However anyone who has had exposure to this journey, whether they are staff, citizen or provider will acknowledge that the actual journey and the steps and actions around this are far more complex. This slide attempts to capture these complexities, and in particular emphasises that it is not a linear process but that people can move back up the journey or out of it altogether at various points. enablement prevents requirement for ongoing support Continually look for opportunities to enable, signpost or give advice to increase independence Encourage to the left, not inevitable drift to the right 20

Implementation planning Elements of transformation On what is there already a INSERT LOCAL AUTHORITY consensus? At what stage should other decisions be made in? Blueprint Implementation planning Implementation

Breakdown of activities for target operating model The following slides demonstrate how the transformation framework can be applied to the self-directed support element of the customer journey The principles and questions which are raised for each stage (e.g. blueprint, implementation) can be applied across the transformation agenda.

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Initial contact assessment Provision of information for individuals using or interested in social care services (including self-funders) is essential to allow genuine choice and control. This covers information available via all channels (web, phone, face-to-face etc) at first enquiry stage and throughout the process. Develop new information resources – print & online Decide role of Council’s contact centre (e.g. will the council do initial telephone assessments?) Explore options for on-line contact Review appointment system with professional staff Develop information for self-funders Training and development for ASC & customer contact staff Implement procedures to ensure information is consistent across all channels Agree how to work with partners (public, provider and voluntary sector) in the provision of information and other support that people will be signposted to Work through and agree the interface with services providing low-level interventions, or enablement services and other ‘fast track-able’ or crisis support Review triggers for assessments

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Assessment The traditional care assessment and management process will need to be redesigned to enable transformation. Assessment includes determining eligibility and the personal budget amount which typically involves developing an operational Resource Allocation System (RAS) and defining the role of self-assessment. This may have an impact on current role definition and team structure of social worker/care managers. Decide on approach to self-assessment & when to make citizens aware of their budget Develop assessment questionnaire Develop Resource Allocation System Refine financial assessment Decide how to validate and risk manage assessments Put appropriate risk management arrangements in place Ensure integration with other assessments (CAF, other funding streams etc) - minimum signposting role Adapt back office systems to support these functions Define the role of social workers & care managers and changes to role descriptions and team structure Develop training plan

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Indicative Personal Budget Calculated At this stage the person is informed about their personal budget and about any appeals process. Decide how best to communicate this information Agree processes for approving indicative personal budget allocations Decide appeals process Agree policies for exceptional and transitional allocations Adapt back office systems to support these functions

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Support planning The traditional care assessment and management process will need to be redesigned to enable self-directed support. People can use any combination of resource (third sector, friends, family, social workers, care managers) to develop their support plan. The council will retain a role to risk assess and approve support plans. Decide maximum and minimum levels of assistance to be offered and by whom Utilise existing resources in the community Develp new support planning approaches to offer genuine choice and stimulate creativity while managing risk Consider boundaries for what personal budgets can be spent on Define the role of social workers & care managers and changes to role descriptions and team structure Develop training plan Adapt back office systems to support these functions

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Authorisation & validation The council will continue to retain a role in ensuring that support plans will meet the identified needs of individuals and that their legal responsibilities are met. To do this there needs to be an effective process to agree support plans. Agree a process for the authorisation of support plans Develop guidance for social workers to negotiate changes to support plans, in line with support planning guidance Agree an appeals process if people do not agree with social workers when determining the support plan

Breakdown of activities for TOM Go Live/expansion/optimisation – service implemented and commenced In a self-directed support system, citizens can choose to control their personal budget in a variety of ways. There will also be the need to ensure people have the assistance they need to secure the support specified in the support plan. Agree how to maximise the resource deployment options - direct payment; a representative, a legal trust, an independent support organisation or a provider manages the funds on their behalf; services provided or procured by the council; or a combination of these methods Agree the control mechanisms over each method Develop processes for supporting these different types of personal budget Design structure and standard content of contract between the person and the local authority Decide which aspects of organising support the council will support and which aspects it will rely on external providers for role of local authority under self-directed support Decide what parts of the cost of organising support appear within the personal budget Identify and consult with current or potential organising support providers Decide if the cost of organising support should be included in a personal budget Creation of resource directory Define the role of social workers & care managers and changes to role descriptions and team structure Develop training plan Adapt back office systems to support these functions Blueprint

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Monitor & review Quality assurance and review will be different under transformation. This includes the development of outcome based reviews, ensuring support plans are being delivered and also responsibility for understanding how personal budgets have been spent. The relationship with monitoring suppliers’ quality will also be different if this support was commissioned by individuals. Develop a process to monitor outcomes and a basis for agreeing individually how often support plans will be reviewed Produce review forms/templates/guidance documents Develop risk management framework to help ensure that the level of scrutiny undertaken on how individuals spend their budget is appropriate to risk Decide on level of quality assurance for providers Define the role of social workers & care managers and changes to role descriptions and team structure Develop training plan Adapt back office systems to support these functions Collate evaluation information to inform the next phase

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Understanding needs and commissioning Under a self-directed support system the council no longer has direct control over where a significant proportion of the adult social care budget is spent. The market will be responding to individuals choosing what services they receive as well as any contracts that the council chooses to put in place. The roles of strategic commissioning, contracting and contract monitoring will fundamentally change. Find ways to learn about what people want Develop better information on needs and future demand including self-funders Explore how and how much the council can influence the market and where it will get its intelligence about what people want to buy from Map market in area Consult with providers Decide what's in house & what's commissioned Charging policy Strategy for existing contracts Adapt financial, care management & back office systems to support these new functions

Breakdown of activities for TOM Blueprint Breakdown of activities for TOM Back office services Allocating spend and procuring services on an individual basis will require fundamentally different back office processes and systems. This will include IT facilities as well as auditing, invoicing and payment processing. Assisting individuals in managing their finances, including through third sector providers will also require different processes. All these processes will need to be scalable i.e. some processes will work for small numbers of people but will be impractical for large numbers. In addition, different systems will be required to support both back office processes and delivery of care services.. Decide back office processes for supporting different types of personal budget (e.g. direct payment, provider facilitated, nominal budget for procuring in-house services, combination) Refine and simplify direct payments processes Undertake analysis to better understand current spend, service user numbers and unit costs Adapt financial, care management & back office systems to support these new functions Develop risk management framework to help ensure that the level of scrutiny undertaken on how individuals spend their budget is appropriate to risk

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

How do we define the success of the Transformation agenda? Does our definition of the success of transformation need updating?

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

Getting started – defining a limited launch in Phase 1 Who will be involved in the pilot? – Client group? – Transition / new clients / annual review / all? – Other factor (e.g. locality / type of provision / team)? Size? – How many clients will be involved in the pilot? Speed? – How quickly will clients be brought into the pilot? What are the key issues for each of the elements of transformation when running a pilot?

Contents Introduction What is success? What changes? Success revisited Getting started Next steps

Next steps Report to DMT Move to Blueprint stage Communications