www.england.nhs.uk

Learning Disabilities:

Share and Learn Webinar

Alex Fox

CEO - Shared Lives Plus

28 July 2016

Personal Health Budgets, Integrated

Personal Commissioning and

Transforming Care

Di Domenico

Personalisation Lead, Learning Disability

Programme – NHS England

Shared Lives: the connection test

www.england.nhs.uk

Date Topic Guest speaker Venue

25 Aug 2016

Co production – a long term relationship and

different Conversations

and

Transforming Care and Building the Right

Support – the CQC approach to registering

services for adults with learning disabilities

Samantha Clark, Chief Executive, Inclusion North

Theresa Joyce and Sue Mitchell - Care Quality

Commission

Webinar

29 Sept 2016

To be confirmed To be confirmed Webinar

27 Oct 2016

To be confirmed To be confirmed Webinar

24 Nov 2016

To be confirmed To be confirmed Webinar

26 Jan 2017 To be confirmed To be confirmed Webinar

23 Feb 2017 To be confirmed To be confirmed Webinar

30 Mar 2017 To be confirmed To be confirmed Webinar

Learning Disabilities: Share & Learn webinar programme

www.england.nhs.uk

Personal Health

Budgets, Integrated

Personal

Commissioning and

Transforming Care

Di Domenico, Personalisation Lead – Learning Disability Programme

July 2016

www.england.nhs.uk

Claire has a personal budget

You can see her story at

www.cpstrust.co.uk

The My Life My Way initiative in Hampshire will

give many more people the chance to have

choice and control via an integrated health and

social care personal budget

www.england.nhs.uk

Claire used to live in residential care. Because of her

personal health budget she now lives in her own home

and can enjoy sailing. Not only that …

www.england.nhs.uk

… she met with Simon Stevens, chief executive of NHS

England. They talked for 2 hours about how more

people like Claire could get choice and control.

Personal Health Budgets: national

policy context

• Continuing healthcare: since Oct 2014 people receiving NHS Continuing

Healthcare (and children receiving continuing care) have had the right to

have a personal health budget.

• Children and Families Act 2014: children who have special educational

needs should have a single assessment, an Educational, Health and Care

Plan and the option of a personal budget.

• The NHS Mandate 2020: sets the expectation that by 2020 50-100,000

people will have a personal health budget or integrated budget. This

could include people with Learning Disabilities, beyond the Transforming

Care Cohort

• The 2016/17 Planning Guidance: CCGs to develop “Sustainability and

Transformation Plan” and sets the expectation that personal health

budgets and integrated budgets should be an integral part of these plans.

• Building the Right Support (Transforming Care): Implementing personal

health budgets and integrated budgets are a key part of realising the

ambitions

www.england.nhs.uk

What is a Personal Health Budget?

• A Personal Health Budget is an amount of money to

support a person’s identified health and wellbeing needs,

the application of which is planned and agreed between

the individual, their representative, or in the case of

children their families, or carers and the local NHS team

• It is not new money but rather the money that would

normally have been spent by the NHS on a person’s care

being spent more flexibly to meet their identified needs

www.england.nhs.uk

The Essential Parts of a PHB

The person……

• knows upfront how much money they have available for healthcare and support

• is enabled to choose the health and wellbeing outcomes they want to achieve, in dialogue with one or more healthcare professionals.

• is involved in the design of their care plan.

• is able to request a particular model of budget that best suits the amount of choice and control with which they feel comfortable.

• is able to spend the money in ways and at times that make sense to them, as agreed in their plan.

www.england.nhs.uk

Part of the solution:

• Radically change the relationship between the health professional and patient to a much more equal one.

• Centre around a care plan and focus on outcomes

• Delivers integration at individual level and higher quality care.

• Works well for people with the highest support needs.

• Enable a wider range of possible solutions than traditionally commissioned services. Not new money

• Promotes self-management and reduces reliance on NHS services.

www.england.nhs.uk

PHBs enable people to do different

things, this rightly stimulates debate

• Look at the whole picture not just one aspect of care in isolation

• Proactive vs reactive approach to planning/delivering care

• What was the health outcome/need, and did the things agreed in the care plan meet these? What is the traditional NHS solution?

• What is the evidence for both the traditional option and what the PHB is being used for

• Consider overall cost effectiveness, what is the overall impact of the PHB ?

www.england.nhs.uk

Integrated Personal Commissioning

• At its most basic Integrated Personal Commissioning (IPC) shifts control to service users to plan and shape services that fit with their lives.

• It moves the relationship with services from ‘what’s the matter with you’ to ‘what matters to you’. For the first time it allows service users control over spending on themselves across health, social care, as well as key areas like education for children with complex needs.

• Described as a ‘new commissioning model’, with individuals who have complex needs given the option of ‘commissioning’ their own care through an integrated personal budget.

• Nine sites are testing out these new models, 5 of which are focussing on people with a learning disability – more demonstrator sites planned

www.england.nhs.uk

What needs to be different at an

individual level? • One person at a time: supporting people to live in their own

home or family home – at same cost or less than conventional services

• Outcome-based: focus on what matters to the person and their family, build on people’s assets and interests

• Whole-life, whole family approach: housing, education, employment, leisure and interests, not just health and care needs

• Joined-up - transition from children to adult services, and between social care and health

• Tailor-made solutions: Direct payments, individual service funds/third party budgets, equipment, support from hand-picked, well-trained people

• Risk enablement: thinking differently and being creative

• Developing peer support and VCS: peer networks, support planning, advice and advocacy

www.england.nhs.uk

What needs to be different at a

strategic level? • Strong leadership – a clear vision that is communicated and

shared

• Individual champions – and wider support for a more person centred approach

• Accessible information – in different formats and easily available

• Peer networks - “tell it like it is”

• Build confidence in the system – adequate plans for scale and pace in personalised approaches

• Joint NHS/social care processes and infrastructure

• Training and workforce development in a range of person centred approaches

• Market development using intelligence from experts by experience

• “What isn’t forbidden is possible”

www.england.nhs.uk

Learning so far: what can help

• Ensuring a strong voice for people with learning disabilities and families throughout

• Using people’s stories and promoting good practice

• Targeting family carer and self-advocacy groups to raise awareness

• Peer support and independent brokerage

• Holistic and personalised support planning

• Start young!

• Commitment to joint working

• It shouldn’t matter where the money comes from!

www.england.nhs.uk

Learning so far: pitfalls

• Can be hard to make the right links locally

• Senior people need to be on board

• Caution and risk aversion

• “Ping pong” between children’s services, adult

services and NHS/social care

• “What’s new/we are already person-centred”

• It takes a lot of work and time to make change

happen even for a few people

• Focus only on individual at expense of strategic

change

www.england.nhs.uk Personal health budgets – Accelerated development programme 17

If you’re going to do it, do it right

• Evaluation – showed that PHBs work best for those with the most complex needs BUT the benefits depend on how they were introduced.

• Best results – people know budget up front; advice and support available; choice and flexibility over how to spend budget , choice on how it is managed, knowing the ‘offer’.

• Scale-up - challenge of maintaining the integrity of the values.

• To work well, personal health budgets need: - good support from all parts of the system - co-production with people with direct experience

www.england.nhs.uk

What Support is available?

www.england.nhs.uk

What is already available

• Stories and films

• Guide to PHBs for people with learning disabilities

• Personal health budgets toolkit and FAQs

• Learning network and discussion forum

• Regional networks

www.personalhealthbudgets.england.nhs.uk

www.england.nhs.uk

Resources and information

• NHS Choices

• Personal health budgets: Including people with learning disabilities

• More resources about people with learning disabilities:

• stories and films

• delegation and risk

• Advice on employing personal assistants

• Third party budget and ISFs

• Joint commissioning across age groups and agencies

www.england.nhs.uk

• IPC targeted support: On-site support to areas taking part in the Integrated Personal Commissioning programme

• This will focus initially on the 9 existing IPC sites; there will be an option to expand more widely during 2016-17 which may also include TCPs.

• The objective will be to develop a set of places that are taking the lead in implementing personal health budgets and integrated personal budgets, and building this into the local approach for Transforming Care.

• Information from IPC sites will be shared via the Sustainable Improvement Programme

What will be available 16/17 - IPC

www.england.nhs.uk

Questions

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www.england.nhs.uk

Shared Lives: the connection test

Alex Fox, CEO

Shared Lives Plus

www.SharedLivesPlus.org.uk

http://alexfoxblog.wordpress.com

http://vimeo.com/108993357

Karl and Clare with Shared Lives carers Blossom and

Mike, at their wedding, before moving to live

independently

Kent Shared

Lives

www.england.nhs.uk

James

www.england.nhs.uk

From a report by Your Voice Counts 2015.

Shared Lives is when you live

with a family or one carer in

their home and they help and

support you with what you

need.

A chance to have a

life with their

family.

When I moved into shared lives my carers

saved my life, I was depressed and being

bullied before I went to live with them.

Now I feel so much better.

I love everything about

my life: now I feel like I

belong to a family.

Where I live now is the best place

I have ever lived. I have my

freedom but I know people care

about me and I feel safe.

What Shared Lives means

to me

www.england.nhs.uk

• Achieves great outcomes like

(lots of!) new friends.

• Government inspectors say

Shared Lives is consistently

better and safer.

• £26,000 a year lower cost per

person.

Safer, better, lower cost

www.england.nhs.uk

Shared Lives Plus is the UK network for Shared Lives and

Homeshare. Our members are Shared Lives carers, Shared

Lives schemes and Homeshare programmes.

Shared Lives Plus was established in 1992 and has over 5,500

members UK-wide, including 5,000 of the UK’s Shared Lives

carers and almost every Shared Lives scheme and

Homeshare programme.

Our sister organisation develops the micro- and community

enterprise sector and supports Shared Lives development:

www.CommunityCatalysts.co.uk

Who are we?

www.england.nhs.uk

Transforming care

Shared Lives has demonstrated it can be part of the solution:

• A distinct support choice available in nearly every area

• Adaptable for people with complex needs

• A twin focus: great care and a great life.

A different ethos:

• ‘Independent’ doesn’t have to mean living alone.

• A good life is about friends, family, purpose, love.

• Asset-based: people contribute to a household & community

Personalisation: lessons from social care, RSA: http://goo.gl/QSlDg

www.england.nhs.uk

• The Shared Lives carer’s house feels

like a family home.

• Participants share home and family

life, either living together or through

the adult visiting their Shared Lives

carer regularly.

• Organised by 150 registered local

schemes who recruit, train, support

and monitor Shared Lives carers.

“You see people grow - they blossom.”

Sharing home and family life.

www.england.nhs.uk

The Shared Lives carer role

Personal & unpaid

• Sharing home

• Sharing family life

• Family & friends help

• Visible & valued

• Build informal networks

• Holidays together

• Professional personal care

• Max 3 individuals

• Self-employed: no ‘staff’

• Trained & paid (not p. hr)

• Can use ‘support carers’

• 4 weeks paid breaks p.a.

Professional, paid.

Shared Lives

www.england.nhs.uk

Shared Lives relationships

Shared Lives carer

Shared Lives

agency

Care manager

Advocate

Local council or NHS

Shared Lives Plus

Government

inspectors

Families

www.england.nhs.uk

Shared Lives carer

assessment and approval

Shared Lives Haringey • Rigorous 3-6 month

assessment and approval

process.

• Looks for skills, values,

attitudes and knowledge.

• Considers housing and

rest of household.

Initial meeting Application & interview

ID & DBS, references

Training pre & post approval

Approval process

Approval panel

www.england.nhs.uk

Shared Lives carer

My family

Shared Lives matching

Shared Lives carer family

Me • Matching takes time, but

pays huge dividends.

• Short breaks can be part of

matching.

“It’s like extending

your own family.”

Paper matching Involve family

Meeting Activities Overnight, Weekend

Trial period

www.england.nhs.uk

Shared Lives consistently outperforms all other regulated care.

Inspection results 2015

The number of scheme staff stayed static this year (8% increase last year).

Increase workloads and turnover pose a risk to continued high safety and

quality.

www.england.nhs.uk

Shared Lives: outcomes

‘Firsts’ for 500 individuals using Shared Lives:

• 35% learned a household task

• First ever holiday: 30% (UK) 16% (abroad)

• First boyfriend/girlfriend: 12%

• 26% joined a club not

exclusively for disabled people.

• Almost all made friends.

• 34% of service users had

made five or more new friends.

Our outcome measuring tool has

been piloted for launch soon.

www.england.nhs.uk

Shared Lives carer

John Shared Lives

scheme

How the funding flows

£

£

£

£

Local Council or

NHS

£ Housing benefit

£

Disability benefits

£

1 coordinator

to 25

supported

individuals

(live-in).

Payment for

care includes

4 weeks’ paid

breaks p.a.

1

2?

3? Staff team & office

Recruiting,

training,

supporting

Shared

Lives carers.

www.england.nhs.uk

Shared Lives growth in

England

In England in 2014-15 11,570 people were being supported

in arrangements, an increase of 2450 (27%) in two years.

www.england.nhs.uk

Regional variation

www.england.nhs.uk

• Lancashire Shared Lives supports 11% of people with learning

disabilities who receive support. If all areas did this, 7300 more

people would use Shared Lives, saving £227m.

• Vivo Care Choices in Cheshire West support 3% of older

people who access support. If all areas did this, 23,860 more

people would use Shared Lives, totalling 25,600.

• Herefordshire Shared Lives supports 2.6% of people using

mental health services. If all areas caught up, 6000 more people

would use Shared Lives, saving £42.7m

• If all areas caught up with the best performing, 37,000 more

people would use Shared Lives (48,600 in total) saving £145m.

The areas out in front

www.england.nhs.uk

Connect

people &

families

Our national role

Shared Lives Plus

Support Shared Lives carers

Raise

awareness

& influence

Innovation

research

& grants

Awareness

Support

local

schemes

Families Advice

skills &

learning

Protect

the values

& ethos

www.england.nhs.uk

Mental

health

support

We support innovation

Shared Lives

Parent & child

Transitions

& young

adults

Domestic

violence

Awareness

Older

people &

dementia

Families Offenders

substance

misuse

Out of

hospital

www.england.nhs.uk

A number of approaches are arranged around

informal networks & fostering social action:

• Shared Lives

• Homeshare

• Local Area Coordination

• Circles of Support

• Micro-enterprise development

• KeyRing networks

Could we challenge all interventions to connect people?

The connection test

www.england.nhs.uk

Alex Fox, CEO,

Shared Lives Plus,

alex@SharedLivesPlus.org.uk

www.SharedLivesPlus.org.uk

07738641897

http://alexfoxblog.wordpress.com

Twitter: @alexsharedlives

• The new social care, Royal Society of Arts, 2013: http://goo.gl/6NPnP;

• Can we have a People Powered NHS? RSA, 2014: http://bit.ly/1psacBe;

• Our 3 minute film: http://vimeo.com/108993357

Contact details

West Wales Adult

Placement