Will personal budgets be the norm in five years’ time? Seminar report

Posted on November 9, 2011 by OPM

Last week OPM hosted the latest in our public interest seminar series, which was a great success: excellent speakers and a really lively debate about vitally important issues. The conversation has continued outside of the debating hall, and one of the participants has already posted his view of the key points. Below is our short report – of course it’s impossible to convey every single contribution, so please do have your say via the comments box! If you’re interested in being put on the mailing list for future seminars, then please contact us at seminars@opm.co.uk.

Personalisation seminar report

A debate: ‘Self-directed support and personal budgets will be the norm in five years’

Posted on October 27, 2011 by OPM

Will self-directed support and personal budgets will be the norm in five years time?

Join us for a lively debate on this topic. This event is part of our long-running series of public interest seminars.

When

Thursday 3 November, 6:00 pm for a 6:30 pm start, finished by 7:45 Continue reading →

Does the Dilnot report on funding social care risk reducing care home residents’ quality of life?

Posted on July 5, 2011 by OPM

By Antonia Bunnin, OPM fellow.

So, the much-anticipated Dilnot report has been published, and appears to deliver an elegant solution to an almost intractable problem.

Much of the initial response has focused on a number of key questions. Crucially, can the report gather enough political consensus and momentum to avoid being kicked into the long grass by government? How affordable is the £1.7 billion initial price tag, and what are the costs of doing nothing? Will the financial sector rise to the challenge, and develop intelligible products that are attractive and affordable to the majority – or will it fail dismally by adding too much complexity, too many exemptions, and making people feel that they are being ripped off?

And even if quality financial products are introduced, will people with middling wealth act rationally by purchasing them? Or will they prefer to ‘bury their heads in the sand’ or take the risk that ‘it won’t happen to me’?

Commentators have understandably focused on big questions. But one recommendation has received scant attention, but could have huge implications for the quality of our care homes. Continue reading →

Supported personalisation: The example of ecdp pass

Posted on May 23, 2011 by OPM

While recently interviewing users of ecdp pass – a payroll service operating across Essex to help disabled people and their families recruit and employ personal assistants or carers using a personal budget – I was struck by how becoming an employer can be a significant undertaking for individuals and families.

For the users of ecdp pass who had some experience of entirely self-managing the recruitment and employment of personal assistants, it often seemed quite onerous. They had to complete and submit tax returns, pay holiday leave in advance and issue pay slips. In the words of one interviewee:

‘Particularly if you’re employing more than one personal assistant, it can feel like your suddenly running a small company without any experience or training.’

To my mind, these views and experiences underline the importance of organisations and professionals properly supporting the personalisation of social care in a way that does not undermine its empowering potential.

ecdp pass, with funding from Essex County Council, provides a good example, where a ‘process only’ approach – that is, removing much of the administration involved in employing carers without impinging on users’ rights and responsibilities as an employer – was thought to be a success:

‘It [ecdp pass] is like having a supervisor there, providing you with back-up support as the employer.’

At a time when empty mantras about empowerment and personal responsibility are repeated ad nauseam and public servants are cast as ‘enemies’, the example of ecdp pass and others like it, present a more complex reality where organisations and professionals still play a crucial role in properly supporting individuals and families to feel empowered.

To learn more about OPM’s work on personalisation.

By Chris Reed, OPM researcher

Having personalisation as the norm: OPM, LGID, In Control and Action for Children report

Posted on February 25, 2011 by OPM

One of the biggest strategic challenges for UK government at all levels is to renegotiate the relationships between public services (whoever is providing them) and service users and the public. Personalisation and individual budgets through which we can establish co-production and sometimes copayment relationships provide the answer, particularly now that we know that we can achieve better long term outcomes as well as budget savings.

In November last year OPM worked with LGID, In Control and Action for Children on a conference about personalisation and individual budgets for children and the report has just been published. In addition to young people and parents, participants included a rich mixture of service providers, policy makers and commissioners. The discussions were both broad and deep with an emphasis on practice rather than theory.

OPM’s particular contribution was to explain how leaders in children’s services could commission a system in which personalisation and individual budgets are encouraged, or even the norm. Personalisation and individual budgets do not work as a stand alone programme. They require whole system change which in turn relies on excellent leadership from people who understand that they are first and foremost strategic commissioners able to shape services round service users rather than around the needs of professionals and traditional services. Localism is potentially helpful because it removes some of the central government controls which have been identified as barriers to individual budgets. However people at this conference were worried that local leadership was not strong enough to rise to the challenge without central government support. They also worried about the post code lottery.

We had hoped to have the Minister, Sarah Teather with us and the report contains questions for her raised by groups of participants. We look forward to working with LGID, In Control and Action for Children to circulate the answers and offer any support we can to the government departments as well as local government in response to the considerable ‘social movement’ now behind personalisation and individual budgets in the coming months and years.

By Judith Smyth, OPM director

Why do some people choose cash payments over council-managed services for adult social care?

Posted on October 18, 2010 by OPM

Many people who now receive a personal budget still choose to receive council-managed services.

But the people we’re speaking to as part of a three-year study of personal budgets in Essex have chosen to do things differently and opt for cash payments, which they can spend themselves.

So why did these people choose to take this on when others didn’t? A common motivating factor for taking cash payments – expressed by people in this study and in others – is the desire to exercise greater choice and control. But many people must feel the appeal of this. So what encourages some to go for it and others not to?

Emerging findings

A number of ‘external’ factors appear to influence people’s decisions, including the availability of services through local markets and the role of frontline staff.

But our research has also emphasised the importance of a number of ‘personal resources’ available to service users, including the confidence and skills they are equipped with and the availability of support and advice from close friends and relatives and wider social networks.

Findings so far suggest that a combination of these ‘personal resources’ and external factors play an important role in shaping the degree of choice and control available to service users, the practical decisions they make and ultimately the outcomes they achieve.

As such, contrary to much discussion among practitioners, researchers and policy makers to-date, the appropriateness of cash payments for adult social care does not appear to be determined by age or impairment type. More accurate predictors of take-up of self-managed budgets may be the confidence of service users based on their own sense of rights, their skills and the support they have from relatives and friends.

Relationships matter

There is a clear two-way dynamic in the relationship between personal budgets and social networks. On the one hand, personal budgets can be used to increase opportunities for social interaction; on the other hand, existing networks and close family relationships are important both in encouraging take-up of cash payments and influencing the way they are used.

In addition to the role played by a number of close friends and relatives, confidence and perceived capacity to manage a personal budget is also influenced by whether service users believe they have access to wider social networks through which they can identify people they can pay to provide services. Those who have access to people they can employ appear to be at a distinct advantage to those who do not, both in terms of the ease with which they can find ‘providers’, but also in terms of being able to think more creatively about ways to spend their personal budgets because they do not have to pay agency rates. As such, service users with strong social networks appear, in many cases, to be better placed to get more from their personal budgets than those who do not.

For service users and relatives who seek to identify a company to provide services, one of the major frustrations can be their inability to judge the quality of the services until they are in place. Many service users rely on personal contacts to provide informal recommendations about which service providers they should use. This reliance on informal recommendations and advice, although seeming to work well for those who have access to it, again highlights the advantage people have if they have access to social networks that can provide them with this information.

What next …

In this year’s interviews for the study, now underway, we’re looking at whether the confidence, skills and social networks people said they drew on to set up their personal budgets, have a continuing impact in terms of their experiences of managing their cash payments and ultimately the outcomes they achieve.

The findings so far also raise important questions, which are relevant beyond the personalisation agenda. Broader policy debates – including discussions about how to nurture the government’s aspirations for the Big Society – will need to work through some of the same issues.

Encouraging and enabling us to be more active citizens, where we take responsibility for our own communities and services, will need consideration of how to foster the confidence, relationships, skills and creativity to do this.

By Sally Neville, OPM fellow

Reablement works – but do people really understand it?

Posted on October 7, 2010 by OPM

On the same day that Channel 4 News and Pulse magazine warned of an impending ‘care home crisis’ driven by funding cuts and rising complaints, the Government announced £70m for primary care trusts to spend on reablement services to support people leaving hospital.

In policy terms, this is exactly the right place to be investing resources. More and more evidence show that reablement services can lead to major and sustained improvements in the well-being and independence of vulnerable people. At the same time, effective reablement services can reduce the need for care home placements, and the number and size of home care packages needed, by helping people regain the confidence and skills they need to continue living independently at home.

Investing more in reablement now should mean councils having to spend less on care homes and home care in future. And although there is no direct evidence yet, many believe that reablement also has a knock-on effect for the NHS in terms of fewer hospital admissions.

Confusion remains

But reablement remains poorly understood. There is no single definition, no single service model, and no single group of staff who deliver reablement. Many NHS and social care staff, as well as members of the public, are still unclear about what reablement actually means, and the benefits it can bring.

The point about staff is crucial: the success of any reablement service will depend on the support, engagement, knowledge and skills of the frontline staff who deliver the service, and those who work closely with them.

What is reablement?

At heart, reablement is about helping people to do things for themselves, rather than doing things to or for people. It’s about supporting the whole person – addressing their physical, social and emotional needs. It’s an outcome-focused, personalised approach, whereby the person using the service sets their own goals and is supported by a reablement team to achieve them over a limited period, typically six or eight weeks. It focuses on what people can do, rather than what they can’t, and aims to reduce or minimise the need for ongoing support after reablement.

The kinds of reablement support are many and varied. Encouraging and motivating people are central to what reablement staff do. Reablement might involve helping someone practise walking to regain mobility, taking them shopping to build their confidence in using public transport after a fall, or ensuring they have the equipment needed to live at home. Support is often intensive, and provided by a range of professionals.

The best reablement services are excellent examples of new approaches to social care: providing more tailored and personalised support, offering people more choice and control over the kind of care they receive, helping people to be independent for longer, and achieving better outcomes for users.

For reablement to develop effectively, it is vital that the large numbers of staff likely to be involved – directly or indirectly – in providing reablement in future, and their managers, understand the concepts, approaches and benefits of reablement. An understanding of reablement will become increasingly important for staff at all levels across the whole health and social care economy. Key areas of skill and knowledge that need to be developed are:

The policy drivers – understanding what is driving the development of these approaches, and the links with personalisation
Benefits of reablement – for individuals, staff, local authorities and the NHS
Understanding the service from the inside – what a good reablement service is like from the point of view of those who use it, and of staff
What reablement is and isn’t – the similarities and differences between reablement and prevention, home care, intermediate care and rehabilitation
Different approaches – the variety of reablement services, service models, client groups, and funding arrangements

By Antonia Bunnin, OPM fellow

A new measure may revolutionise social care commissioning

Posted on July 27, 2010 by OPM

Local authority commissioners have previously relied on crude cost comparisons or followed historical patterns to make commissioning decisions, lacking ‘the most basic evidence of service quality or efficacy’. Personal budgets have shown that given choice over which services to use, individual users may shun services that commissioners previously would not have thought to query.

A new tool, the adult social care outcomes tool (Ascot), is the social care sector’s first measure that offers a systematic assessment of the relative value of services to the individual. Ascot offers a measure of social care productivity, crucially, in these times of massive budget cuts, allowing the sector to demonstrate its worth and giving social care commissioners an invaluable tool to improve service quality and social care outcomes.

http://www.guardian.co.uk/society/joepublic/2010/jun/09/ascot-measure-adult-social-care

Chris Reed

OPM blog

Category Archives: Personalisation