ISFs in Action Transforming lives and budgets
Choice Support • Charity and company limited by guarantee, established in 1984. • Work with people with learning disabilities, mental health problems, physical disability, autism, Asperger's syndrome, homeless. • Turnover £40 million. • Employs 1600 staff. • Support 1000 people. • Operate in Wakefield, Mansfield, Oldham, Stockport, Congleton, Nottinghamshire, Bedfordshire, Milton Keynes, Buckinghamshire, Hampshire, Portsmouth, 9 London boroughs.
Population 287,000 10th smallest borough by area 3rd most densely populated 47% public sector housing 10th most deprived borough in London 41st most deprived borough in England 11% unemployment Some Information about Southwark
Diverse population 75% school population from BME 100+ languages spoken in schools 3 MPs Labour controlled Some Further Information
Southwark 2010 • 152 people supported • 66 registered care, 32 supported living, 54 outreach support • Block contract - £6.5 million – 83 people
Summary of key achievements • The old block contract has been converted to 83 ISFs with 83 personalised support plans created. • ‘Waking-nights’ have been removed from 11 services (29 people) making Southwark ‘waking-night’ free. • Increased use of Assistive Technology. • 18 care homes are de-registered. • Phased closure of a former PCT campus-like site. • A Shared Lives service has been established. • Local authority offered a £1,795,073 reduction in price on a £6.5 million contract (29.75%).
How savings were achieved (i) • Reducing the direct cost of hourly support rate. • Reducing local and central overheads to 15% of ISFs. • Reducing provision of support based on person centred plans (PCPs). • Deregistering existing homes
How savings were achieved (ii) • Reducing the cost of each support hour i.e. changes in existing staff terms & conditions and management restructure. • Reducing direct support hours, including waking nights and increased use of Assistive Technology (AT). • Reducing overheads and closure of the local office.
Research and evaluation Better Nights, Bucks New University (2012) ISFs in Action: Personalising Block Contracts, CfWR (2012) http://www.centreforwelfarereform.org/ Feeling Settled, NDTi (2011)
Replacing waking nights Research by Social & Health Evaluation Unit Bucks New University identified three key benefits • Outcome 1: Cost reduction • Outcome 2: Safety maintained • Outcome 3: Quality enhanced
Replacing waking night staff: Outcome 2: Safety maintenance Three issues were identified as involving potential risks • The first was people having seizures and whether they would be detected and managed without regular observation. • The second was urinary incontinence and whether people would experience undetected discomfort. • The third was nocturnal activity and whether people might harm themselves or others. The research concluded that the change was well managed, risks were well assessed and that safety was maintained after the removal of waking night staff
Replacing waking night staff: Outcome 3: Quality enhancement (i) • Utility bills are cheaper because lights and electrical appliances are not working at night. • Cost in regards to each person’s ISF (individual service fund) is less for the individual. • People are more settled generally with a better sleep pattern. • There aren’t so many handovers which distracts staff members and is invasive. • There is more consistency of support due to new shift patterns
Replacing waking night staff : Outcome 3: Quality enhancement (ii) • Everyone goes to sleep at the same time. • Staff have become more trusting of peoples’ abilities. People have more privacy and autonomy. • There is no longer confusion around day or night. There is an end and a beginning to the day in regards to staffing so now people don’t seek to engage at night and sleep better therefore they are more productive and calm during the day. • A number of people have just developed the skills and confidence to go and do what they want to without support.
Key success factors (i) • Public commitment by Southwark Council and Choice Support to work closely together and build relationship based on real trust. • Start looking forward, not back. • Simple rules, but attention to detail. • When stuck, go back to simple rules. • You need good financial support.
Key success factors (ii) • A dedicated senior and experienced manager. • A simple process for the creation of ISFs. • Council delegating assessment process to Choice Support. • Research and evaluation: external validation and scrutiny. • New person centred commissioning approach.