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Insert Local Authority Transformation Strategy Workshop Insert date This document is part of the personalisation toolkit www.dhcarenetworks.org.uk/personalisation. Introductions Your name and role Your current level of knowledge of the transformation agenda and self directed support. Contents

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slide1

Insert Local AuthorityTransformation Strategy WorkshopInsert dateThis document is part of the personalisation toolkitwww.dhcarenetworks.org.uk/personalisation

slide2
Introductions

Your name and role

Your current level of knowledge of the transformation agenda and self directed support

slide3
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide4
Objectives

Gain a shared understanding of the transformation agenda

Agree what transformation means for INSERT LOCAL AUTHORITY

Plan what work needs to be done when

Agree how to approach a pilot

slide5
Transformation agenda- What’s it all about?
  • Universal services – Adult social care must provide support for all adults with social care needs and their carers, including signposting and help in accessing a range of services that are available to all including services outside of adult social care such as transport, leisure, health and education.
  • Social capital – developing the community and encouraging individuals to make use of all resources available to them in the community, including personal networks (family and friends), community groups, the voluntary sector and other informal support
  • Prevention and early intervention
    • Helping people maintain good health and independence with low level support.
    • Identifying people at risk of losing independence and giving them support early.
    • Helping people get back on their feet after illness, for example through “enablement”.
  • Choice and control – ensuring people have greater choice and control over their lives, including through self-directed support.
slide6

Prevention and Intervention have a

vital role

There are activities at every stage which can improve quality of life and reduce demand

Institutional avoidance

Timely discharge

Lifestyle

Practical support

Early intervention

Citizenship

Information

Enablement

Crisis / flexible response

Low to moderate needs

General population

Complex needs

Substantial needs

slide7
Benefits of transformation

Benefits for users

– Increased choice and control

– A shift in power from the council to the individual

– Greater flexibility

– Prevention and early intervention improves quality of life

Benefits for councils:

– Increased transparency of resources and budgets

– Greater flexibility and equity in provision across all adult groups

– Greater awareness of support networks that exist in the community

– More efficient process

‘Putting People First isn’t just a vision for social care. It demands that all parts of local government ask some fundamental questions about the types of communities they want to build’

Phil Hope, Minister for Care Services, 2009

slide8
Co-production

Co-production is a key part of this agenda

Real change can only happen by engaging users and carers throughout

Personalisation means empowering people to develop solutions that work for them

Putting People First… “seeks to be the first public service reform programme which is co-produced, co-developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services and to win the hearts and minds of all stakeholders’, especially front line staff”

slide9
No longer IF but HOW

‘Transforming social care’ makes it clear that all local authorities have to change their social care model and that this will involve a significant amount of work.

“We have a long way to go to give everyone more choice and control over the care and support they receive. Local councils are clearly working hard to transform their systems to do this. We need to work together with local communities to ensure this progress continues.”

Phil Hope, Minister for Care Services, May 2009

slide10
No longer WHEN but NOW

Councils and partners are working to deliver significant progress by 2011.

“The information given to us from councils indicates very strong progress amongst a number of councils. We are confident that this will become widespread over the coming year”

Jeff Jerome, National Director for social care transformation, May 2009

slide11

IBSEN report

  • The IBSEN review of the individual budgets pilots was published in November 2008, with a carers evaluation published later.
  • The key findings included:
  • More people felt in control of their lives
  • More people taking up direct payments
  • Many people continued to use mainstream services
  • - Need for better access to support planning and brokerage
  • Mixed evidence about the early outcomes for some people
  • Some challenges about making it work for some groups (such as older people)
  • - Mostly positive results for family carers
slide12

Transformation framework: summary

Phase 1

Switch On

Full Potential

Investigation

Blueprint

(Enhance)

Investigation

Blueprint

(Review)

Blueprint

(Develop)

Implementation

Planning

Implementation

Planning

Implementation

Planning

Implementation

Implementation

Implementation

Monitor & Sustain

Limited Launch

Expanding the new approach to all

Optimising the systems

slide14
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide15
What counts as a success?

Success is about service wide transformation - offering a personal budget or increasing direct payments is not enough, but is a key step

The principle is to offer maximum control and choice while effectively managing risk

The development of universal services and social capital have an important role to play

Co-production is a key tool in transformation

Reducing demand on services through a combination of prevention and early intervention.

slide16
Defining success for INSERT LOCAL

AUTHORITY

What elements constitute successful implementation of transformation?

Which of these can we measure?

Can we define success in one sentence?

When can we describe transformation as “mainstreamed”?

slide17
You need to define what success means in your area

Various perceptions of success

Genuine choice and control?

Increased

Social

Capital?

Maintain/ improve CQC rating?

Improve-ment in outcomes?

Greater control over limited finances?

Efficiency?

Inclusion of more funding streams?

A new ‘agreement’ with citizens?

Avoiding bad press?

More Co-production?

Evidence of new options in the market?

Less reliance on local authority?

Demon-strable culture change?

Everyone acting as self-funders?

slide18
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide19

The Customer Journey

Universal

services and

early

intervention

initial contact assessment - advice and signposting

Meet immediate needs and enable

Assess

Calculate

initial personal budget

Support plan

Authorise

&

validate

Go live

Monitor & review

Early intervention

Self-directed support

how can you help customers stay independent
How can you help customers stay independent?

Those not eligible for a package can get further information

Review may suggest enablement

Universal

services and

early

intervention

Calculate

initial personal budget

First contact - advice and signposting

Meet immediate needs and enable

Assess

Support plan

Authorise

&

validate

Go live

Monitor & review

enablement prevents requirement for ongoing support

Continually look for opportunities to enable, signpost or give advice to increase independence

Encourage to the left, not inevitable drift to the right

slide21
Elements of transformation

On what is there already a INSERT LOCAL AUTHORITYconsensus?

At what stage should other decisions be made in?

Blueprint

Implementation planning

Implementation

slide22
Breakdown of activities for target operating model

The following slides demonstrate how the transformation framework can be applied to the self-directed support element of the customer journey

The principles and questions which are raised for each stage (e.g. blueprint, implementation) can be applied across the transformation agenda.

slide23

Blueprint

  • Breakdown of activities for TOM
  • Initial contact assessment
  • Provision of information for individuals using or interested in social
  • care services (including self-funders) is essential to allow genuine
  • choice and control. This covers information available via all channels
  • (web, phone, face-to-face etc) at first enquiry stage and throughout the process.
  • Develop new information resources – print & online
  • Decide role of Council’s contact centre (e.g. will the council do initial telephone assessments?)
  • Explore options for on-line contact
  • Review appointment system with professional staff
  • Develop information for self-funders
  • Training and development for ASC & customer contact staff
  • Implement procedures to ensure information is consistent across all channels
  • Agree how to work with partners (public, provider and voluntary sector) in the provision of information and other support that people will be signposted to
  • Work through and agree the interface with services providing low-level interventions, or enablement services and other ‘fast track-able’ or crisis support
  • Review triggers for assessments
slide24

Blueprint

  • Breakdown of activities for TOM
  • Assessment
  • The traditional care assessment and management process will need
  • to be redesigned to enable transformation. Assessment includes
  • determining eligibility and the personal budget amount which typically involves
  • developing an operational Resource Allocation System (RAS) and defining the role
  • of self-assessment. This may have an impact on current role definition and team
  • structure of social worker/care managers.
  • Decide on approach to self-assessment & when to make citizens aware of their budget
  • Develop assessment questionnaire
  • Develop Resource Allocation System
  • Refine financial assessment
  • Decide how to validate and risk manage assessments
  • Put appropriate risk management arrangements in place
  • Ensure integration with other assessments (CAF, other funding streams etc) - minimum signposting role
  • Adapt back office systems to support these functions
  • Define the role of social workers & care managers and changes to role descriptions and team structure
  • Develop training plan
slide25

Blueprint

  • Breakdown of activities for TOM
  • Indicative Personal Budget Calculated
  • At this stage the person is informed about their personal budget
  • and about any appeals process.
  • Decide how best to communicate this information
  • Agree processes for approving indicative personal budget allocations
  • Decide appeals process
  • Agree policies for exceptional and transitional allocations
  • Adapt back office systems to support these functions
slide26

Blueprint

  • Breakdown of activities for TOM
  • Support planning
  • The traditional care assessment and management process will need to be
  • redesigned to enable self-directed support. People can use any combination of
  • resource (third sector, friends, family, social workers, care managers) to develop
  • their support plan. The council will retain a role to risk assess and approve
  • support plans.
  • Decide maximum and minimum levels of assistance to be offered and by whom
  • Utilise existing resources in the community
  • Develp new support planning approaches to offer genuine choice and stimulate creativity while managing risk
  • Consider boundaries for what personal budgets can be spent on
  • Define the role of social workers & care managers and changes to role descriptions and team structure
  • Develop training plan
  • Adapt back office systems to support these functions
slide27

Blueprint

  • Breakdown of activities for TOM
  • Authorisation & validation
  • The council will continue to retain a role in ensuring that support plans
  • will meet the identified needs of individuals and that their legal responsibilities
  • are met. To do this there needs to be an effective process to agree support plans.
  • Agree a process for the authorisation of support plans
  • Develop guidance for social workers to negotiate changes to support plans, in line with support planning guidance
  • Agree an appeals process if people do not agree with social workers when determining the support plan
slide28

Breakdown of activities for TOM

  • Go Live/expansion/optimisation – service implemented and commenced
  • In a self-directed support system, citizens can choose to control their
  • personal budget in a variety of ways. There will also be the need to ensure people
  • have the assistance they need to secure the support specified in the support plan.
  • Agree how to maximise the resource deployment options - direct payment; a representative, a legal trust, an independent support organisation or a provider manages the funds on their behalf; services provided or procured by the council; or a combination of these methods
  • Agree the control mechanisms over each method
  • Develop processes for supporting these different types of personal budget
  • Design structure and standard content of contract between the person and the local authority
  • Decide which aspects of organising support the council will support and which aspects it will rely on external providers for role of local authority under self-directed support
  • Decide what parts of the cost of organising support appear within the personal budget
  • Identify and consult with current or potential organising support providers
  • Decide if the cost of organising support should be included in a personal budget
  • Creation of resource directory
  • Define the role of social workers & care managers and changes to role descriptions and team structure
  • Develop training plan
  • Adapt back office systems to support these functions

Blueprint

slide29

Blueprint

  • Breakdown of activities for TOM
  • Monitor & review
  • Quality assurance and review will be different under transformation.
  • This includes the development of outcome based reviews, ensuring support plans
  • are being delivered and also responsibility for understanding how personal budgets
  • have been spent. The relationship with monitoring suppliers’ quality will also be
  • different if this support was commissioned by individuals.
  • Develop a process to monitor outcomes and a basis for agreeing individually how often support plans will be reviewed
  • Produce review forms/templates/guidance documents
  • Develop risk management framework to help ensure that the level of scrutiny undertaken on how individuals spend their budget is appropriate to risk
  • Decide on level of quality assurance for providers
  • Define the role of social workers & care managers and changes to role descriptions and team structure
  • Develop training plan
  • Adapt back office systems to support these functions
  • Collate evaluation information to inform the next phase
slide30

Blueprint

  • Breakdown of activities for TOM
  • Understanding needs and commissioning
  • Under a self-directed support system the council no longer has direct
  • control over where a significant proportion of the adult social care budget
  • is spent. The market will be responding to individuals choosing what services they
  • receive as well as any contracts that the council chooses to put in place. The roles of
  • strategic commissioning, contracting and contract monitoring will fundamentally change.
  • Find ways to learn about what people want
  • Develop better information on needs and future demand including self-funders
  • Explore how and how much the council can influence the market and where it will get its intelligence about what people want to buy from
  • Map market in area
  • Consult with providers
  • Decide what's in house & what's commissioned
  • Charging policy
  • Strategy for existing contracts
  • Adapt financial, care management & back office systems to support these new functions
slide31

Blueprint

  • Breakdown of activities for TOM
  • Back office services
  • Allocating spend and procuring services on an individual basis will require
  • fundamentally different back office processes and systems. This will include IT
  • facilities as well as auditing, invoicing and payment processing. Assisting
  • individuals in managing their finances, including through third sector providers will
  • also require different processes. All these processes will need to be scalable i.e.
  • some processes will work for small numbers of people but will be impractical for
  • large numbers. In addition, different systems will be required to support both back
  • office processes and delivery of care services..
  • Decide back office processes for supporting different types of personal budget (e.g. direct payment, provider facilitated, nominal budget for procuring in-house services, combination)
  • Refine and simplify direct payments processes
  • Undertake analysis to better understand current spend, service user numbers and unit costs
  • Adapt financial, care management & back office systems to support these new functions
  • Develop risk management framework to help ensure that the level of scrutiny undertaken on how individuals spend their budget is appropriate to risk
slide32
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide33
How do we define the success of the

Transformation agenda?

Does our definition of the success of transformation need updating?

slide34
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide35
Getting started – defining a limited launch in Phase 1

Who will be involved in the pilot?

– Client group?

– Transition / new clients / annual review / all?

– Other factor (e.g. locality / type of provision / team)?

Size?

–How many clients will be involved in the pilot?

Speed?

–How quickly will clients be brought into the pilot?

What are the key issues for each of the elements of transformation when running a pilot?

slide36
Contents

Introduction

What is success?

What changes?

Success revisited

Getting started

Next steps

slide37
Next steps

Report to DMT

Move to Blueprint stage

Communications