Supporting Choice and Control

1. What needs to change if we are to have a social care market fit for people to self direct their support?

2. “The future is like heaven – everyone exalts it, but no-one wants to go there now.” James Baldwin 1961 First independent survey of 50% of 60 In Control citizens showed remarkably increased satisfaction for no additional resource, movement to ordinary settings, citizens achieving their life plans.

3. Supporting Choice and Control • Self Determination. • Person centred thinking, working, planning and reviewing. • Outcomes focussed. • System to be responsible, not risk averse.

4. Current market • Block contracts • Tendered services • Relationship between LA and provider • Predominantly service led • Arguably un-person centred • Target and performance focussed.

5. Future market • Flexible, individualised contracts between provider and person using services • Community capacity and good prevention • Social capital and payments in kind • Innovative solutions • Creative expenditure • Person centred, outcomes focussed.

6. Three main options: • Input-focused efficiency - reducing the costs of support services. • Process-focused efficiency - finding more creative and appropriate ways of delivering support. • Needs-focused efficiency - reducing the need for paid support - primarily this will mean increasing capacities of citizens and communities. Given rising demographic pressures, a focus on building community capacity may be the only real way to make Social Care economically affordable in the long-run.

7. How – in theory. • build a more enabling relationship between individuals and state (& beyond social care) • extend support to people not currently eligible for Self Directed Support to increase individual capacities • connect with wider community development activity to strengthen social capital.

8. How – practically. • Village halls • Churches • Schools • Shop4Support • Local Area Coordination • Micro-providers • Time Banks.

9. The Commissioning Cycle. The focus of commissioning needs to shift to creating the right environment for innovation to flourish in.

10. Challenges to the System: • Procurement / tendering to become more inclusive. • Different contractual framework needs to be developed. • Different approach to market management. • Much broader range of support solutions. • Coping with greater diversity of purchasing arrangements. • Keeping up to speed – systems take longer to evolve than theory and practice. • Financial planning and budget management. • Applying Individual budgets to people already in services. • Recording and monitoring activity. • Whole systems change.

11. Challenges to the System:Practice Issues • Individual Budget changes logic – no longer think service first / where are the vacancies? • Person Centred Support Planning directs resources to focus on broader options – housing, employment, education, leisure, relationships. • Acceptance of risk within positive risk taking framework. • Partnership with individuals, advocates,families and providers: co-production. • Loss of expert role in defining solutions.

12. What have we learned? Strategic planning needs to take place across the whole system. Early focus equally on: • Developing workable RAS. • Communication: engaging with people who use services, families and staff within existing services. • Support planning and reviewing. • Procurement and market management. • Provider sign up.

13. A new approach. “The governing principle behind good approaches to risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same.” (Independence, choice and risk: a guide to best practice in supported decision making – DH, May 2007.) The balance of power is shifting.

14. Final thoughts: Real Wealth.

15. Thanks for listening. Louise Close. In Control England. www.in-control.org.uk