Reflections by Dr Simon Duffy Centre for Welfare Reform

Yorkshire & Humber Action Learning Set

ISFs and Personalised Support

Individual Service Funds were originally designed to enable citizenship for people who needed help managing their own support

They are not ‘magical’ but they are helpful in enabling citizenship for all

Out of these initial insights and practices emerged a more coherent approach to support we might call personalised support

• Not pure ‘brokerage’ • Managed budgets • Working closely with people

and families • Hyper-individualised

In Australia this is also becoming known as shared management…

You don’t need to do everything yourself - it’s a partnership

Returning to Inclusion Glasgow recently it struck me that this was also about forming robust relationships where trust could flourish

Available research (while still limited in scope) shows significant quality and efficiency improvements.

A survey carried out by the Centre for Welfare Reform shows that this model has been growing for over 20 years and existed in other countries even before it came to Glasgow…

• 20 Years - Inclusion Glasgow (Scotland) • 20 Years - Neighbours Inc (USA) • 20 Years - Quality Lifestyle Support (Australia) • 23 Years - Pameijer, Gaandeweg (Netherlands) • 24 Years - Durham (Canada) • 25 Years - Spectrum (Canada) • 25 Years - Community Living (Australia)

Personalised support also seems to be working for many different groups or needs…

There is no one model, but there are some consistent elements of organisation design…

• Note that personalised support does not come from standardised person centred planning tools

• The hardest thing seems to be to find commissioners or funders who value flexibility

• Standardisation is the opposite of personalisation • It is not a matter of being ‘clever’ but of shifting creativity into the

hands of people and families • But without dumping responsibility on them

• The battle for citizenship and lives of meaning goes on.

• Margaret had lived life blighted by institutional abuse from an early age.

• She left Lennox Castle Hospital 20 years ago and uses an Individual Service Fund managed by Inclusion Glasgow.

• Over time her service evolved into a wonderful form of shared living and family life.

• But today Glasgow Social Services are planning to move Margaret from her home into a Nursing Home.

Individual service funds are not always used by providers of personalised support, but there is a high correlation for those with a long-standing provision of high quality personalised support…

An interesting boring graph

InclusionGlasgow

There is an ongoing and international problem around funding flexibility from commissioners. Some providers fall back on direct payments…

Some commissioners are starting to see that they can contract for flexibility…

It’s important to note that contractual flexibility is not the same as using an ISF (which is really a matter of provider practice not a contractual form).

We’ve along way to gobut there is some growth

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www.individualservicefunds.com

• Steven Rose of Choice Support spoke about developments in Southwark, Central Bedfordshire and Wakefield. All involve work to transform support who were living in group homes (often small residential care homes).

• In Southwark a major contract was individualised, contract price decreased and large quality improvements. Challenge to change way of thinking for staff. Resource allocation process was managed by the service provider and frontline staff had a good idea of what a fair budget would be.

• In Bedfordshire services are being transformed to ISFs - one at a time - now 3 people have ISFs and support is improving. Approach starts by working with team around the person. Savings will come later.

• Wakefield have agreed to a large scale transformation of £6+ million contract for c.100 people. Mass planning and resource allocation process was used to begin the process. Looked at reducing waking nights, reducing group living or consider shared living. Target saving £0.75 million identified. Working with social workers on new assessments and prioritising those most eager to change.

• This process is putting an end to the unacceptable process of competitive tendering.

• Some families do become fearful of change, but it’s important to work through the process of building more positive solutions.

• Liz Leach and Ash of Imagineer, is a small organisation based in Calderdale. Liz formed the organisation 2004 after years working as a person centred planning facilitator. Organisation combines independent planning and practical facilitation of solutions, including ISFs, but not a service provider.

• ISFs are one option available, alongside direct payments and commissioned services. People are looking for flexible solutions that allow for changing needs and which don’t burden people.

• Working with several local authorities and CCGs to develop personalised solutions. Most people have not heard of ISFs and didn’t have the mechanisms necessary to make this happen.

• To have ‘client accounts’ you have to be registered with the Financial Services Authority, which is difficult to achieve.

• Ash described how he lives alone, with support from PAs. Personal assistance is about relationships, not qualifications. It is a challenge to employ my own PAs. Without freedom and control he wouldn’t be able to live his life.

• Angela Gardner of Calderdale Council explained how they combined the development of a register of home care providers to be contracted outside the home care contract, with a ‘light touch’ contract.

• Reviewed 600+ people who received home-care and 50% wanted to keep their support provider. Some people wanted an ISF so they could change their provider.

• Initially the providers carried on doing what they’d always done. Today 608 people using an ISF in Calderdale, provided by 27 service providers, including some new entries into the market. It is still just a register.

• There are more people with ISFs than commissioned home care and about the same as the number for direct payments. Now started to included people with learning disabilities in group living and in mental health services. The Care Act 2014 has helped confirmed the way forward.

• 50 visits, often people didn’t know that they had an ISF and recent survey data is confused. Social workers are still often confused. Many organisations are not tracking their budgets properly. Major issue on how charging and back office functions should work.

• Now encouraging asset-based approaches to engage people with community. Indicative budgets being reintroduced, with more flexible support planning and simpler outcome based reviews (using POET). Savings have come, not directly, but by preventing residential care.

• Prepayment cards to be used, no separate bank accounts and reduce time for auditing, charging and appropriate reclaims - no intention to manage how money is used. Intention to pay 4 weeks in advance, and to pay net of contributions. New guidance and joint training for everyone.

• Martin Walker described some of the national developments. • Helen Turner - regional ADASS for West Midlands - is coordinating an

Action Learning Set on ISFs e.g. Birmingham to start ISFs in January, Coventry, Solihull, Staffordshire, Shropshire actions under way.

• Interesting development in Dorset, cf. Chris Watson • Work developing around Integrated Personalised Commissioning (3rd

party budgets in the NHS) • Work going on to review progress on Care Act and effectiveness of

• Leeds - Direct payments are now being used as ISFs via one of the neighbourhood network schemes. Care packages now being managed at the neighbourhood network level (Local Links) using a brokerage approach [helping people employ or commission their own support].

• Doncaster - Drive to increase direct payments, rather than ISFs. • Wakefield - At start of work with Choice and others to convert block

contracts into ISFs. But still early days. • Lincolnshire - Proposal to pilot ISFs in extra-care housing and desire to

start to use outcome-based contracting (cf. Birmingham). • East Ridings - Not yet using ISFs. Legal and procurement are very

powerful influences. • Sheffield - Lots of third party direct payments. • North Yorkshire - An ISF pilot which was successful in home-care, but

current work on ISFs has not developed as hoped. • N. Lincolnshire - Some interesting developments in home-care. • Connect to Support - A possible framework for managing ISFs.

• How ISF and direct payments are implemented is a function of the level of trust, not just in providers, but in Adult Social Care within an authority.

• Shouldn’t social workers be part of the quality assurance process? • Are people themselves aware of what ‘good enough’ means? • Can people be connected into circles or networks where people have a

way of checking out what is appropriate or what others are doing? • We can empower people to be there own monitors? • People can move from a ‘time and task’ focus to an outcome focus over

time, it can help build the relationships upon which creativity will flourish. It’s not just about the paperwork.

• ISFs can be a gimmick if not used in the right spirit.

Discussion: