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Making Progress! Autumn/Winter 2009
Jane North, project manager of the Self Directed Support projects talks about what is currently happening on the project.
Hey, Personal Budgets are no longer just one of those great ideas! In Nottinghamshire we have over 500 people receiving a Personal Budget. Some people have chosen to have theirs as a direct payment, some have their Personal Budget managed by us and we arrange services on their behalf, and some people have chosen to have a ‘mixed budget’ - a combination of a managed budget and a direct payment.
We also have 1,300 people on a direct payment through the ‘usual way’ - following a community care assessment. Local people now have their own budgets and are making their own choices about what support and care they need to live their lives.
You will be able to check out local stories about how people are using their Personal Budgets on a DVD. From December, “Personal Budgets, Your Life, Your Support, Your Way” will be available to view online www.nottinghamshire.gov.uk/puttingpeoplefirst. As well as personal stories from service users and carers there is also a social care worker’s perspective’, a Q & A section and an ‘introduction to Putting People First’ section. If you want a copy of the DVD email selfdirectedsupport@nottscc.gov.uk or telephone Katie Barber on 0115 977 2516.
National picture
Nationally, more than 20,000 people now have their own personal budgets and to keep the pressure on, the Department of Health and heads of local government have set new targets for councils for Putting People First.
One target is that by October 2010 all new service users and carers and all service users who are up for review will be moved on to a Personal Budget. Another target is that by April 2011, 30% of people who are eligible for social care will have taken up Personal Budgets. And by 2012 it is expected that everyone eligible will be on a Personal Budget. Check out all the targets for Putting People First in this ADASS / LGA / NHS agreement
Health personal budgets
Work is also underway in developing personal health budgets for people with long term health conditions in Nottinghamshire.
Fiona Cambridge the ‘Staying in Control’ project manager talks about the purpose of the project. “Work is underway in developing personal health budgets for people with long term neurological conditions in Nottinghamshire. The Staying in Control Project will give people the chance to decide how, where and by whom they want their care to be delivered. People will be in control of their package of care, by developing their own support plan and choosing their provider. It is hoped this will raise the well being and quality of life for patients, carers and their families. We have started recruiting people to the project which will end in 2011 when a report of our findings will be produced.”
Resource allocation system
Now, let’s talk about the RAS - Resource Allocation System, to the uninitiated! (No, don’t leave at this point, I need to mention testing too, but please bear with me.)
The RAS works out how much money someone is entitled to for their Personal Budget. And we are doing a lot of testing to help us develop a RAS that is fair, sustainable and focused on outcomes for people. So far, we have well over 1,000 assessments to use for this work. This is great news and will help get this work right for people. A big thanks to everyone who has taken part. We still have more work to do and plan to have a RAS available to start using with people who are moving onto a Personal Budget from April 2010. We call this ‘live’ testing and it means we can see how the RAS works in practice.
Support plan and review
Getting the right outcomes (the goals that people want to achieve) for people is what the new support plan and review tool is all about. Over the last few months we have been testing the new tools with staff and service users and asking lots of people what they think about them. These new tools will help us report back to the Department of Health on outcomes for monitoring our performance.
“Identifying service users’ outcomes in the support plan is the point in the process where genuine personalisation begins. The outcomes should be personal, meaningful and important to the person’s quality of life and include goals and aspirations and by definition unique to the individual” Ian Baker, commissioning officer, SDS team.
Support to users and carers
A recent survey by think-tank DEMOS, which Nottinghamshire took part in, found that there is a big task ahead in supporting users and carers with Personal Budgets.
Work is underway in developing new brokerage services that can help people make informed choices about the support and care that is right for them. We plan to have pilot brokerage services set up by Spring 2010.
Jane Nandi, commissioning officer, SDS team, talks about the brokerage pilots. “The plans for the pilots are progressing well, and all the staff affected will have a chance to have a say in what will happen in the pilots. We are aiming to have all the work done to get the systems in place to run the pilots by February 2010. We will then be trialling what brokerage will look like when the Self Directed Support goes live in October 2010”.
The DEMOS survey also showed good support for day services with 31% of service users saying that they would spend their money on these services. There was also strong demand for personal assistants (PA), who are hired directly by service users to provide them with support, with 44% saying they would want a PA if they had a Personal Budget.
Here, Sandrina Mapletoft, SDS commissioning officer tells us about a new questionnaire. “We will soon be sending out a questionnaire to service users, “Using Direct Payments to employ Personal Assistants”. We will be including separate questionnaires for the PA to complete. We want to find out what training and development needs there may be for service users and PA, and how we can best support them.
If you employ your own staff, but have not received a questionnaire by the end of the year and you would like to complete one, please contact the team by emailing: selfdirectedsupport@nottscc.gov.uk, or telephone: 0115 977 3234 so we can send you one.” To read for yourself the findings from the national survey that Nottinghamshire was involved in, go to
http://www.demos.co.uk/publications
Choice in the market place
Personal Budgets are nothing without choice in a growing market place. We are working closely with providers to prepare for the changes ahead with Personal Budgets. In September 2009, we held a conference for small providers called Offering Real Choice: Developing a Diverse Social Care Market.
Commissioning officer from the SDS team, Byron Wilks said: “There was a buzz about the day and all delegates positively engaged in all the activities on offer. I’m sure they went away with a better understanding of what Self Directed Support means and how they can contribute to its development in Nottinghamshire.”
Helen Turner, commissioning officer from the Putting People First team, talks about the next steps, “Nottinghamshire is a large county; we want to encourage and stimulate small local services such as micro providers to meet the needs of people in their local communities. We are aware of gaps in services in rural areas and some hard-to-reach groups. We are planning to work closely with NAAPS (National Association of Adult Placement Schemes) to develop the right approach to micro providers in Nottinghamshire, both existing and new.”
Previous news
Testing of the assessment tool took place during June and July to make sure we had got the questions right and it can be used across different service user groups. The results of the testing will enable us to start work on the all important resource allocation system (RAS) and to start allocating points against the questions and comparing this against the costs of how we currently provide services.
We briefed 70 managers on the assessment tool and got feedback on the blueprint for self directed support. Thanks to your efforts we received a total of 138 assessment forms back, but still need some assessments back from some service user groups to get a good representative sample of the types and amounts of services we commission.
The results of this phase of testing will help us plan the second phase of testing in September and October when we need 1200 assessments completed. Alongside every assessment, re-assessment and review we need a SDS assessment completed. This needs a big push by us all to get this important work done during a time when we are all feeling the pressure. To help with this work, 14 full time agency social workers with 2 years post qualifying experience will be joining teams across the department to help pick up the extra work. The results from this test will give us the vital information to develop the Nottinghamshire RAS. It will help us move towards affordable and sustainable personal budgets in the future. A workable RAS is planned for early 2010, but does depend on how well the testing goes.
An early lesson for us from the first phase of testing is that staff need more training in the assessment tool. It is quite different from how we have assessed in the past and we plan to run practical training sessions in early September. Further details will be out soon. In the meantime if you have any questions about the testing then contact Ian Baker on 0115 977 3234.
During the summer we have started to move people who receive Independent Living Fund onto a personal budget. Amanda Marsden has been working closely with teams. It has been an opportunity to try out the support plan and test out some of the challenges of personal budgets with people with complex needs and multiple funding streams. We will be feeding back our learning to the Independent Living Fund and will help inform the national consultation on Right to Control.
Right to Control is a national programme from the Office for Disability Issues (ODI) and is the next phase for personalisation for disabled people. To find out more check out www.odi.gov.uk/working/right-to-control.php. The ODI is inviting local authorities to put in a bid to be a trailblazer site – a new buzzword for us! Wendy Lippmann is working on this and has set up a working group. If you want to find out more or how to get involved in the consultation, contact Wendy Lippman on 01623 434290 or email wendy.lippman@nottscc.gov.uk
During the summer Ian Baker will be consulting widely on the support plan and review document. Look out for it on the intranet and other places. Make sure you take the chance to have your views heard.
Over the last few months we have widely shared the blueprint for self directed support. Basically, it shows a pathway for how a user would go through self directed support in the near future. It is based on the work of in control and the 7 steps and further work developed by the Department of Health, but shaped by how things will look like in Nottinghamshire. Now we need to move this on to how this would actually look like in your assessment teams. We will be working with some operational managers on this during September and October. To help us plan how the new changes will work Jane Nandi is planning a brokerage pilot to run in an older person’s team first. Brokerage is a vital step in self directed support – it enables people to select, plan and organise their preferred support and will be a move away from how we have done things in the past. Largely, brokerage will be an in house service and we now need to test how this will work.
“Many of the skills and expertise required for brokerage already rests with people within social care and we need to build upon this.”
In June the second Putting People First newsletter was published – to find out more about what we are up to check out our Putting People First page or contact Lynne Cutts on 0115 977 3234 and we will send you a hard copy.
The pace of change in self directed support is hotting up – there is just 18 months before 30% of all service users and carers need to move over onto a personal budget. New milestones leading up to March 2011 is expected soon from the department of health with targets to hit over the next 18 months. Watch this space!
Jane North, Project manager for Self Directed Support, updates you on what's been happening during May 2009:
We’ve listened to the extensive feedback on the assessment and it is now ready for its final testing. A survey was held to decide on the name of the assessment - what to call it was becoming a source of much heated debate. (Well, it was for us!) We had a good response with 61 returns and this gave us a clear winner; the form will be called “Self Directed Support Assessment”. Boring maybe, but a very sensible choice! And no chance for any funny acronyms!
The Self Directed Support Assessment is designed to trigger other funding streams, but we do want to go one step further then that and see if we can include or better align other sources of funding. To this end, Anne Tomanek has joined us to look at how we could include supporting people funding in the budget allocation.
Anne says “I hope that my work will help to maximise the personalisation of Supporting People services and identify opportunities to align or integrate Supporting People funding within Self Directed Support”.
We are now testing the questionnaire to make sure we’ve got it right and to start the important step of allocating points to questions so we can work out a personal budget. The testing will take place during the months of June and July - it will be a mixture of live testing in the third week of July and additional desktop exercises in learning disability services and mental health. Briefing sessions for managers are running in June and July.
Claire Binns, the SDS Accountant says “It is important that we get all the returns for this sample so we can start to look at the resource allocation system”.
It is also ‘testing’ times with further trials for Self Directed Support to come. Thanks to your efforts so far, we have moved 331 people onto a personal budget and over 1200 on a direct payment, and we plan to move more people onto Self Directed Support over the coming months. Amanda Marsden led the very first trial of personal budgets with a small band of assessment staff and now you can have the chance of moving someone onto Self Directed Support. In July, Amanda and Sandrina Mapletoft are holding a half day session to show you how to do it. If you are up for it and have a service user who could move onto a personal budget, then email selfdirectedsupport@nottscc.gov.uk for further information. Spaces are limited, so get in fast.
Promoting direct payments is one way of promoting more choice and control for service users and anyone can do this. To help you, Sandrina has written a handy news sheet on direct payments with updates on and lots of practical information. This will be available in a few weeks. For example, did you know that service users can apply for a one off payment of £300.00 for start up costs?
Following the first trial, Amanda has now turned her attention to transferring people who receive Independent Living Fund onto a personal budget. This is a challenging project, which tests the potential of personal budgets to work across different funding streams.
Byron Wilks, who leads on equality and diversity for Putting People First sees the potential of Self Directed Support for people from black and minority ethnic communities and he is committed to seeing 50 people from BME communities move onto a personal budget by March 2010.
He says: “Self Directed Support offers all service users increased choice and control in how their needs will be met and will allow for increased flexibility in receiving support and activities from within people’s own communities. People will have the choice to receive more traditional services or the flexibility to commission services themselves by employing a personal assistant whether through an agency, or even a friend or neighbour. This has the potential to be very effective for people who may not see mainstream services as meeting their immediate needs.”
From direct payments and the trials so far we are learning an awful lot about how to implement Self Directed Support and a report on findings so far will be out soon.
Veronica Bell says “From the trials we are understanding what has changed, what needs to change and what it means for future training.”
Learning has also come out of the recent survey Jane Nandi ran with the help of reviewing officers in older people services and day centre managers in physical disability services. The survey gave us a snapshot of current service users - what services they receive, what they know about personal budgets, and what they may wish to spend their personal budget on in the future.
Jane says “This information will help inform our development of local brokerage provision and our future commissioning strategy.”
And finally, in May we held our first Carer’s Reference Group and their first job was to help Ian Baker decide on what the priorities are for the support plan he has drafted.
Maggie says, “People immediately recognised the importance of support planning and got very involved in the workshop – carers did not have any difficulty in understanding, identifying and prioritising outcomes”.
9 months into the project, a great deal of work has been done, but there is still a way to go!
March - April 2009
Making Self Directed Support a reality has a big impact on all front line staff, not just social workers. We know that we need to get this right so it is has been really important that we got out there and listened to people’s concerns, ideas and experiences. To date we have done over 100 briefings and spoken to over 1000 people from administration staff to in-house providers and assessment and care management staff . And in April we had our first service user reference group and launched Putting People First champions.
Personal budgets
Big progress was made at the end of March when we had our first service users take up the opportunity of a personal budget. We now have over 300 people in Nottinghamshire having more choice and flexibility about how their services are delivered.
Ms H said, speaking about having a personal budget: “I feel as if a lot of my worries have been lifted. I now have the support from somebody I know and can trust. I am happy to have been asked to tell my story about personalised care and how it makes things better for me.”
New assessment form
Making changes for the better can only be achieved with the participation of front line staff and users and carers. So we road tested the Self Directed Support (SDS) assessment form with front line staff and users across the department to find out how it could work better. The feedback was great and has helped us develop the next version, which will be bigger (only joking!) and better.
Ian Baker (from the SDS team) says “Service users tell us they like the simplicity of the form, which enables users to fully engage in the assessment process.”
Amanda Marsden (SDS team) adds “The new assessment is devised in such a way that workers need to have a different type of conversation in order to agree in partnership what support is required in each domain of the form.”
Selected as a site for the national development of an outcome focused review form, we have tested out the new form with front line staff and users in learning disability services and physical disability and vulnerable adults services. This will be out soon for local authorities to use.
Involving people
Real change for users and carers can only be achieved by involving people at every stage. They are represented on the SDS Project Board and have been actively engaged in awareness raising events and conferences (for example at our Service User and Carer conference in December and the Provider conference in April). People have shared their personal stories and experiences of having control over their budget and facilitated group discussions around Self Directed Support. Their stories and these have been included in our newsletters and on the website.
Service users and carers have been consulted on a range of things, from the design of the Putting People First logo to the SDS assessment form. In March, service user and carer reference groups were established and the first meeting of the user reference group took place at the end of the month. These groups provide feedback on the development of SDS. Their views and opinions are valued and are being heard.
Maggie McNamara says “Service users and carers’ views, opinions and feedback are vital to the successful implementation of SDS in Nottinghamshire. The reference group provide a forum for people to meet, find out more about what is happening and share their experiences. People have been very generous with their time and commitment and willingness to be consulted. They have expressed their willingness to be involved – they really want to help make Personal Budgets work for everyone.”
Events
Having more choice means different types of services out there and April saw our first provider event with over 200 providers in Nottinghamshire including in- house services, the voluntary and private sector coming together to get geared up for personalisation and find out what users who have personal budgets are saying.
It really feels like things are starting to come together and over the summer months we want to start talking to you about how self directed support will actually work for you (whether service user, carer, provider or staff) on a day to day level.
