Personalisation in Social Care Services Jeff Jerome

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Personalisation in Social Care Services
Jeff Jerome
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Policy context Commissioning Social care
approach Roles/Workforce
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Context Personalising Care services

• People increasingly expect to receive health and
  care services that are personalised tailored to
  fit in with their lives and focused on keeping
  them well and independent not just dealing with
  crisis situations
• Our Health our Care our Say
• Putting People First
• DArzi

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Putting People FirstA shared vision and
commitment to the transformation of social care

• Central / local Government support, recognises
  demographic challenges
• NHS, Housing, Culture, Leisure, Adult Education,
  Employment etc important to transformation of
  social care
• Information, early intervention, preventive
  services to support independence and inclusion.
• Individuals / carers at centre of planning and
  delivery Control through personal budgets
• Commissioning of services which offer quality and
  ensure individuals are treated with dignity

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Darzi

• . explore the potential of personal budgets, to
  give individual patients greater control over the
  services they receive.
• ..launch a national pilot programme in early
  2009....(to) enable the NHS and their local
  authority partners to test out a range of
  different models.
• Personal health budgets are likely to work for
  patients with fairly stable and predictable
  conditions, for example, some of those in
  receipt of continuing care or with long-term
  conditions.

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Demand Context

• Rising public expectation
• Demographic/Demand Pressures
• Over 85s to increase by 2.5 per year
• 25 over 85s will develop dementia
• One Third over 85s need constant care or
  supervision
• 2 per year increase in people with learning
  disabilities
• High inflationary pressure in sector
• 8-9 pa increase in resource needed
• Resource environment (workforce financial)
  inc. consideration of individual v public funding
  contributions

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Individual / Pathway Perspective

• Most people want
• To stay healthy, active/involved
• If get ill, want cure enabled not disabled
• If not cured, then limit damage/deterioration/redu
  ce pain etc
• Optimise functioning, keep independent as
  possible
• If have deteriorating condition want high
  quality care support, information and good End
  of life care
• Informed, able to choose, and in control re
  prevention, diagnosis treatment, rehab,
  support, care at different points in different
  amounts
• NHS/Council commissioning challenge to get
  balance right

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Commissioning direction

• Joining Commissioning Frameworks to ensure wider
  range of care support services personal,
  sensitive to individual need maintain
  independence and dignity, are safe and effective
• Better prevention, earlier intervention
  promoting health and well-being services across
  NHS and local government, investing now to reduce
  future ill health costs, promote inclusion and
  tackle health inequalities
• Community services in settings closer to home,
  around care pathways, integrated around
  individuals, not providers more support for
  people with long-term needs
• Supported by payment by results and practice
  based commissioning (including financial
  flexibilities) with agreed outcomes, based on
  good JSNA

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Social Care New Approach

• System in which everyone can use their s to
  get care and support for themselves, in a changed
  and developed market
• Private payers, joined by publicly (Council)
  funded personal/individual budget-holders
• Changes to existing resource allocation
  arrangements (?) - points means s (local
  application)
• Try to maximise efficiency of care funding
  minimise bureaucracy/incorporate social capital
  and flexibility

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New Model
Residents in Need
Advice and Information
Assessments

Council Funded Individual / Personal Budget
Self Funders
Individual Direct
LA held Service Fund OR Payment () OR
budget
OWN RESOUCRES
HELP TO BUILD A SUPPORT PLAN
HELP TO NAVIGATE MARKETPLACE AND SECURE SERVICES
ADVICE AND SUPPORT IF THINGS GO WRONG
QUALITY SERVICES DELIVERED DIRECTLY
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Adult Social Care Current Commissioning
Critical
Substantial
Moderate
Low
Higher Wealth
Lower Wealth
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Choice and Control

• Money doesnt guarantee choice or control
• Choice needs a market, information and
  support to choose
• Control involves responsiveness of paid care
  staff/services maintenance of dignity
• Risk, self-determination, self management
• Choice via kite-marking, accreditation,
  regulation etc
• Protection/Multi-agency Adult Safeguarding
• Challenge for commissioners and providers

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The public offer ?

• What might be universal, free or subsidised
• First level advice/info/market mgt/navigation
• Advocacy, protection, some care management
• Prevention, emergency care, treatment/rehab(?)
  etc..
• DASS considerations
• Necessary internal staffing and associated
  processes (e.g. RAS)
• Pre-invested services (eg contracts, buildings,
  preventative services, reablement)
• Balance of free cash for individual budgets
  (de-commissioning)
• Council and cross partner investment (inc joint
  commissioning)

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Delivery (Workforce)

• No assumptions re employer (public or not), but
  different roles
• Opportunities for independent sector development
  
• Care home and domiciliary care provision outcome
  based and personalised more specialised services
  
• Enabling/user-led services use of community
  resources/social capital

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What ( rather than where )

• Roles needed in relation to
• Information/Advice
• Assessment/resource allocation
• Support planning/brokerage/care purchasing
• Employment / PA-Finding
• Review/protection/support/QA
• Community development
• Commissioning
• Hands on care and support of all types
• But all may change !

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SDS Operating Model
Information/ Advice/ Guidance
Rapid Response
Assessment
Care Support Delivery
Review Reassessment
Assessment RAS
Reablement/ Further Assessment
Support Planning
Brokerage
1st Contact/ Screening
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Learning from LB Richmond, so far

• Ensuring the RAS is accurate for great majority
• Charging/subsidy, transparency of costs, CRAG
• Support to staff in process, and in role change
• Introducing re-ablement
• Understanding demand (esp. MH)
• Developing the market

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Conclusions

• Scripting a vision (hearts and minds),showing
  it works
• Ensuring balance PBs only one part of the
  larger picture
• Minimising processes and recognising that most
  people want to minimise contact
• (Joint) commissioning for whole communities. but
  with
• greater individual procurement workforce
  responding
• Engaging providers, users/carers and key
  partners.
• Balancing protection with freedom to choose

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Policy and Implementation

• Understanding/developing PBC and personal budgets
  interface
• The wider social care role
• Better Health, Fewer Hospitals
• New services are shown to work and are valued by
  public
• Hospitals are there when required
• local financial incentives to encourage
  development of person-centred care.
• investment vehicle for delivering the vision e.g.
  pooled budgets especially budgets with one lead
  commissioner
• Costed plans and timetables to re-deploy
  resources

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Commissioning Care and Support

• Developing commissioning as a driver for change
• Joint Strategic Needs Assessments
• Partnerships between commissioners and
  communities interdependence of NHS, local govt
  and independent sector
• Understanding each others systems, and what each
  can offer the public different ways of thinking
  and operating
• Re-designing care pathways, and procuring their
  delivery
• Commissioning for outcomes
• Increasing numbers of individual purchasers
  (public private)

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Joint Commissioning

• Partnership joining the two Commissioning
  Frameworks
• About individualised care pathways, supported by
  payment by results and practice based
  commissioning (including financial flexibilities)
  with agreed outcomes
• Best mix for patients of health/social care/3rd
  sector
• Different contracting
• Budget division Universal services,
  Processes(Staffing), money for Ibs

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SDS Commissioning Issues?

• Whole Community Approach
• Council not major purchaser / procurer?
• Role of individuals as purchaser and commissioner
• Is there a commissioning role?
• Gap analysis
• Market management role ensuring availability and
  choice? Bridging the gaps?

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Policy and Implementation

• Understanding/developing PBC and personal budgets
  interface
• The wider social care role
• Better Health, Fewer Hospitals
• New services are shown to work and are valued by
  public
• Hospitals are there when required
• local financial incentives to encourage
  development of person-centred care.
• investment vehicle for delivering the vision e.g.
  pooled budgets especially budgets with one lead
  commissioner
• Costed plans and timetables to re-deploy
  resources

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So Joined Up approach means..

• A broad approach to commissioning wellbeing,
• not just about the health targets
• Locally driven within national frameworks and
  accountabilities
• Balance support, care, and treatment
• Must involve the transfer of (partic acute)
  health funding
• Moves us towards
• Care closer to home
• Personal budgets whenever possible

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Customer Engagement Models
Specialised interventions
Resource Intensive
Professional gift relationship
Targeted help to individuals
Support to Communities
Universal activities of daily living
Infrastructure for Community development and
self-help
Sustainability
Customer in control
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The Richmond Experience so far

• Initially small number of LAs now mainstream
• Still leading edge exemplar pilots
  (ODI/Finance)
• 18 months of development and implementation
• Complex change process, multi-agency Project
  Board
• Challenges (particularly resource allocation)
• But, 360 people with personal budgets, 80 having
  been assessed via new RAS, almost 5m funding
• Average 250-1200pw (wider re LD, smaller re MH)

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Personal Budgets Breakdown
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Common Governance Framework

• Duty of cooperation
• Health and wellbeing partnerships LSPs
• LAAs as key mechanism for integrated planning,
  priority setting and delivery
• Alignment of planning and budgetary cycles,
  performance assessment and accountability

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