The Changing World: Commissioning and Personalisation

1. The Changing World: Commissioning and Personalisation Andrew Tyson, In Control

2. The Changing World ‘Commissioners will need to change how they work and what they decide to buy, including getting better at listening to people’ (Valuing People Now) ‘Commissioning is at the heart of effective social care...it is the opportunity to transform people’s lives and we should not allow ourselves to reduce the debate just to structures and processes...if personalised care is to be made a reality, current ways of commissioning services will have to change’ (Denise Platt, quoted in DH Personalisation Toolkit)

3. But how?

4. Personalised commissioning: local and national drivers • Local drivers • Efficiency – whole system approach. ‘More for less’ • Preventative – universal services tailored to all • Participation targets – for universal services • Faster start – redesigning other universal and other targeted services in parallel with the implementation of personal budgets • National drivers • Total place – system wide use of resources • CAA – focus on outcomes and delivery through partnership • Role of DASS - as a community shaper • LAAs – outcomes focused and cross sector

5. Developing and effectively using individual and social capital A new citizen – state contract Resilient communities Awareness raising for SDS amongst self funders and current and potential budget holders Reshaping the provider market Providing accessible means of self directing support Enabling people to ‘live a life’ Managing and prioritising the use of public funds Strengthening people’s leverage on the market Ensuring services are personalised Personalised publically funded and commercial services

6. This presentation • Commissioning to support the use of Personal Budgets (and budget pressures) • Beyond Personal Budgets • The culture shift required • How In Control can help

7. Some questions • Who is the commissioner? • How much choice is there? • Who is in control? • Is this really a paradigm shift?

8. 1. Commissioning to support the use of Personal Budgets

9. Accessible means of self directed support:the expanded range of access routes Self care Information and self assessment Service Brokerage Individualised service provision Budget holding by lead professionals Individual service funds Indic-ative budget Direct Payments = self funders = state assisted

10. Awareness raising: marketing self directed support • Budget holders – grapevine; acting as advisors; producing publicity, talking to others, involvement in ULOs • Professional gatekeepers – training and management of care managers to obtain active backing for SDS • Providers – ‘care fairs’; publicising new personalised services; ‘try before you buy’ • Commissioners – orchestrate marketing; enable infrastructure e.g. ‘care fairs’; Shop4Support; regional collaboration on awareness arsing campaigns

11. Accessible means of self directed support: developing the full range of budget management options • Budget holders – providing support and advice to others; user –led organisations as brokers or fund managers • Professional gatekeepers – make people aware of possibilities and always seek to maximise ‘self direction’ • Providers – offer ISFs to both budget holders and self funders: for own and subcontracted services; as a full market brokerage facility • Commissioners – enable the development of a range of SDS options; establish framework contracts and other mechanisms such as electronic marketing e.g. Shop4Support to quality assure the use of ISFs and that care management system is fit

12. Strengthening people’s leverage of the market • Market information – shop4support; kite marked providers • ‘Brokers’ – market knowledge; negotiating discounts • Group deals – group purchasing for personal use; user led organisations as purchasers • Purchasers – offer group and association discounts • Commissioners – framework contracts; quality assurance; transparent pricing; fair pricing

13. Ensuring services are personalised • Budget holders – report on own experience (shop4support); as ‘mystery shoppers’ or inspectors; Partnership Boards, citizen panels, Reach Standards, complaints and compliments etc • Providers – collaborative staff development; self regulation & kite marking schemes; explicit statements of service standards; use independent inspection • Regulators – inspections; de registration applications etc • Commissioners – ‘select list’ framework contracts with built in quality assurance, eg Reach Standards; get the money in the right place for PBs; develop a ‘personalised’ commissioning framework

14. Managing and prioritising the use of public funds: dealing with cuts • Reduce the value of the price point – not recommended by central government • Raise eligibility threshold – may not yield the expected overall savings as more people admitted in higher need at crisis point • Reduce use of residential care – averages 40% of total social care spend. Lowest percentages are around 25%. Invest in alternatives e.g. extra care housing and support at home. • Invest in prevention and rapid reablement – enables independence; reduces the level and time period over which targeted services are needed; and reduces the demand for higher level packages of care

15. Managing and prioritising the use of public funds: some examples • Fighting back • Budget holder associations – support their development as part of good practice but also as a basis from which budget holders can decide whether or not to fight against cuts in eligibility or price points • Reducing costs whilst shielding budget holders • Process efficiencies - re engineer the care management and ISF processes so that the effectively enable SDS to work more efficiently • Reducing service costs • Group deals – enable service users who wish to purchase the same range of services from a given provider or set of providers to negotiate discounts • Service substitution - work with universal service commissioners and providers to enable them to tailor their services to meet a greater range of needs

18. 2. Beyond Personal Budgets – making more of universal services

19. The Continuum of Co-production

20. Source: ‘Coproduction in public services: a new partnership with citizens’, Matthew Horne and Tom Shirley, Cabinet Office, March 2009

21. Current use of the universal - targeted services continuum Targeted services Universal services Care Well-being

22. Potential use of the universal - targeted services continuum Targeted services Universal services Care Well-being

23. Personalising universal services • Non health and social care transformation programmes – make use of wider personalisation or linked initiatives such as Total Place and Respect. • Ownership – all public and commercial universal services see people who use social care as integral to their customer base • Targeted services – focus on supporting use of universal services rather than creating substitutes - inclusion • Co-production – work with people to identify how they can be supported by the universal service to enable more effective co-production of outcomes. • Differentiation – to enable universal services to be accessible, affordable & acceptable to a much wider range of people and life styles - eg DDA • Collaboration – with universal and targeted service providers to enable all people to find a way of using the service that suits their requirements and abilities. • Community run – enable local people, including those who are ‘socially excluded’, to run part or all of any universal service, including budget devolution Based on: ‘Service Transformation through Market Reshaping’, Report for Department of Health, OPM July 2009

24. 3. Changing Culture: some Questions • What are the personal challenges for different actors within the system? • How will our behaviour be different? • What will Local Authorities need to do, as community leaders (place shapers), commissioners and “lead-providers”? • What do other social care providers and universal providers need to do differently? • How might citizen-leaders, family-leaders and community leaders find their place in the new world?

25. Values and Attitudes Changes: • Relationship of citizen with state • What we expect of citizens • What we expect of public servants • How we view professionals and professionalism • Local Authority as commissioner • How we view community

26. An alliance “Effective change in complex systems must come about by leadership from within...systems. It cannot be imposed externally without risking failure and misunderstanding. In Control’s ability to help the successful re-design of social care is closely linked to the fact that In Control was and is an alliance between professionals and those citizens who used social care services.” (Simon Duffy)

27. 4. What we can do to help • Commissioning for Personalisation – joint programme with OPM • A tailored programme with each local authority • Leadership from Adult Social Care, but need ot invite others • Start with LB Hounslow, May 2010 • £8,000/£7,200 for full programme

28. Hounslow programme objectives • Bring together key people from across sectors • Enable each to understand how they can contribute to personalisation • Build relationships • Enable participants to understand the 4 quadrants • Work towards personalising the LA corporate plan and JSNA process

29. A Commissioning Framework • Development of a personalised commissioning framework or set of frameworks, with the money where you need it

30. Contact details www.in-control.org.uk Andrew.tyson@in-contrrol.org.uk