Implementation of Self Directed Support in Wrexham 20072008

1
Implementation of Self Directed Support in
Wrexham 2007-2008

• Compiled by Margaret Gregory and Elaine McGuire,
  Wrexham County Borough Council 2008

2
Introduction

• Wrexham is the first local authority in Wales to
  use Self Directed Support as a method of
  delivering social care to adults with a learning
  disability.
• This presentation contains the following
  information-
• What is Self Directed Support?
• Rationale for Wrexham to Implement Self Directed
  Support
• How does it work?
• Who benefits?
• New Partnerships Pilot how we started
• Implementation
• Top tips and things we now know make a
  difference!

3
What is Self Directed Support?

• Self Directed Support is the natural progression
  from Person Centred Planning.
• Giving people control over their own budgets.
• Choice about how and when they are supported
• Delivering quality services and giving people
  more opportunities in their lives.

4
What is Self Directed Support?

• Knowing up front what Social Services will spend
  on my support and what services cost.
• Being in control of how that money is spent.
• Being able to choose the activities I want to do,
  rather than just a choice of services provided by
  the local authority.
• Being able to choose my own staff, how they
  support me, when and where. I can choose people
  who want to do the same things as me.

5
Rationale for Wrexham to Implement Self Directed
Support

• Council requirement to effectively manage an
  overspent learning disability budget
• Improve quality, choice and flexibility of
  services
• Putting resources in the control of supported
  people, families and carers
• Enabling people to reach their full potential
• Building inclusive communities, where people
  are valued and recognised for their contribution

6
How does it work?

• Self assessment agreed by Care Co-ordinator
• Allocation of Budget
• Person centred plan (helpful, but not essential)
• Support plan agreed by Care Co-ordinator
• Options for managing the budget
• Agreement by resources panel
• Risk enablement panel if necessary
• Review

7
Self Assessment

• Individual completes Self Assessment
  Questionnaire with as much support as necessary
  from someone who knows them well and understands
  them.
• This could include a family member, friend,
  neighbour, advocate, support worker or
  professional, eg. social worker or community
  nurse.
• The self assessment questionnaire is divided into
  8 sections and is multi-choice. It asks
  questions about how the persons disability
  impacts on their life and they tick the statement
  which describes them best.

8
Allocation of Budget

• When the questionnaire has been completed, it is
  checked by a social worker or community nurse to
  ensure that the responses reflect the needs of
  the individual.
• Once agreed, the statements, which carry a
  numerical value, are added up and a formula is
  applied to work out the individual budget.
• The person is then informed of their indicative
  budget. This is the amount that Adult Social
  Care will pay for the individuals social care
  needs during that calendar year.
• Once the person knows what their budget is, they
  can then plan their support.

9
Person Centred Plan

• People do not need a Person Centred Plan to have
  Self Directed Support.
• However, we have found that a great deal of
  valuable information can be contained within the
  Person Centred Plan.
• This information can be used to underpin the
  support plan. Person centred planning tools
  develop dreams and ambitions and give direction
  to the persons life.
• Person Centred Plans are usually developed by the
  individual and anyone they want to support them.
  This may, or may not include family members,
  professionals, advocates, support workers,
  neighbours and friends.

10
Support Plan

• This is a plan of how the budget will be spent to
  meet the persons assessed needs.
• The money cannot be spent on anything illegal or
  anything that puts the money at risk.
• The plan must keep the person healthy, safe and
  well, promote their independence and not put
  anyone else at risk.
• Support plans should be creative, original,
  individual and, as much as possible, community
  based.
• Support plans can be compiled by the individual
  and anyone else whom they choose to be involved.
  This may, or may not include family members,
  professionals, advocates, support workers,
  neighbours and friends.

11
Support Plan

• The Resource Allocation panel will expect to see
  the following issues addressed in a support
  plan-
• The plan should focus on outcomes and demonstrate
  that people are taking part in meaningful
  activities
• That it keeps the person healthy, safe and well
• That it identifies the person/agency providing
  the support
• That it identifies who will manage the support
• That it identifies who will manage the individual
  budget
• It states the contingency amount
• It states the contingency plan and from where any
  emergency cover will be provided
• It identifies all risks and whether there any
  unresolved risks
• Financial assessment has been completed and there
  is a monthly payment schedule

12
The five ways of managing your budget

• Individual Budget Payment you receive an amount
  of money into your designated bank account to pay
  for your own support.
• Indirect Payment you nominate a person you know
  and trust (eg. A close relative), who opens up a
  separate bank account to receive your funding,
  and then they spend it on your support needs
  following your support plan and your instructions
• Independent Trust you set up an Independent
  Trust whose sole purpose is to manage your
  support and individualised budget the Trustees
  spend the money based on your Support Plan and
  considering your best interests
• Individualised Service Fund you choose which
  organisation you want to support you, make sure
  they follow your Support Plan and provide the
  support you want by people you want. They then
  receive the funding directly from Adult Social
  Care, but always account for that money to you,
  as though it is your own money.
• Care Coordination a) if you are unable to do
  your own assessment, planning or organising your
  own support, a Care Co-ordinator, in conjunction
  with family members, friends, other professionals
  and independent advocate to consider your best
  interests, decides how the money is to be spent
  and the Council award a contract/s to a support
  provider.
• b) If having undertaken your assessment and
  support plan you do not wish to be actively
  involved in managing your individual budget, the
  Care Co-ordinator will make the necessary service
  delivery arrangements.

13
Approval by Resources Panel

• Once the support plan has been agreed by the
  social worker or community nurse it is signed off
  by the Team Manager.
• It is then taken to the Resource Allocation
  Panel, which meets weekly, for final agreement.
• The finance department issue an individual budget
  payment agreement form to the budget holder and a
  start date is agreed.

14
Risk Enablement Panel

• Issues of risk must be addressed within the
  support plan.
• We would expect any concerns about the plan to be
  discussed with the relevant people at an early
  stage and resolved.
• If there are any unresolved risks, these can be
  brought to a Risk Enablement Panel. Instances of
  unresolved risk should be rare, it is not
  anticipated that the panel will meet more than a
  maximum of 4 times a year.
• The purpose of the panel is to discuss the
  unresolved risk issues and suggest ways of
  reducing them to an acceptable level, recognising
  that nobodys life is risk free.
• The panel is made up of representatives from
  Adult Social Care and the NHS, also the
  Protection of Vulnerable Adults Co-ordinator and
  anyone else involved in the particular case under
  discussion.
• In very rare instances, it may be necessary for
  Adult Social Care to retain control of the budget
  where severe risks cannot be resolved. In all
  cases, Adult Social Care retains a duty of care
  to the individual.

15
Review

• Four weeks after the budget has started, a review
  is held, to check that everything is running
  smoothly.
• Thereafter, reviews are held annually and the
  self assessment questionnaire is completed again.
• If the social worker or community nurse feels
  there is a need to review more regularly, then
  this can be recommended, eg. 3 monthly or 6
  monthly.
• If the budget has not been completely used up at
  the annual review, the department will reclaim
  anything over 20. This avoids panic spending
  at the end of the year.

16
Who Benefits?

• The Supported Person
• Their Family
• The Community
• Support Staff
• The Local Authority

17
The Supported Person

• I am in control of my own life
• I have real choice I can design a tailor-made
  package of support
• My money can be used flexibly for equipment or
  activities. I can use it creatively and get real
  value for money
• By choosing my own staff and employing them if I
  want to, I am able to have continuity and
  consistency. I get to know them and dont have
  strangers supporting me

18
The Supported Person

• I have my own income, which I can manage with
  support if I need it and have the same rights,
  responsibilities and opportunities as other
  citizens
• The same process is used for everybody in working
  out budgets. I know that it is fair because it
  reflects how my disability affects me, and other
  peoples budgets will reflect how their
  disability affects them
• I have the chance to be involved in my own local
  community. I can use my life experience, my
  abilities and gifts for the benefit of other
  people with learning disability and the whole
  community

19
Families

• Involvement in support planning process having
  a real say / real input into the design of
  individuals support package, channelling
  energies into achieving positive outcomes instead
  of fighting the system
• Re-assurance and peace of mind that their family
  member is receiving the right level of service
• Service provided by support workers who really
  care about the person they are supporting and
  want to give them the best life possible, which
  means promoting their independence
• Shaping the future of social care by not settling
  for any service which is not truly person centred

20
Community

• Benefits from skills, attributes and abilities
  contributed by people with learning disabilities,
  which are currently an untapped resource
• Creating a truly inclusive community where nobody
  feels left out because of their disability
• There will be economic benefits to the local
  community, as people will be more inclined to
  spend money locally, contributing to community
  regeneration

21
Support Staff

• Staff matched to individuals and their
  activities, resulting in staff who want to be
  with the person, doing activities that they are
  also interested in.
• Greater job satisfaction evidence of improved
  quality of life for supported person
• More opportunities for staff and greater
  flexibility, suiting both staff and individuals
• Staff not needing to be trained in areas, which
  are not relevant to the person

22
The Local Authority

• Creative use of funding as individuals often get
  better value for money than the local authority
• Fair and transparent assessment process
  ensuring equality for all
• Control of Adult Social Care budget
• Streamlining administrative processes releasing
  time for professionals to spend on therapeutic
  interventions with individuals and families
• Implementing Self Directed Support will mean that
  local authorities will comply with policy and
  guidance for individuals to be involved in the
  design and delivery of services
• Reduction in bad debt re. charging policy, as it
  is deducted at source

23
New Partnerships Pilot

• Pilot - New Partnerships
• 2005 - 2007 trained families and individuals in
  Person Centred Planning
• 2007 4 families agreed to pilot having an
  individual budget for their family member
• Budget was based on average English figures
• Families were encouraged to think creatively
  about how the funding could be spent to get best
  value for money

24
Stories from New Partnerships

• Value for money - Two young ladies who are
  friends and each have their own budget, when
  going to activities together pay staff member a
  slightly lower rate per hour each, eg. if
  supported 1-1, staff are paid 8 per hour and if
  supported together, each pay staff member 5 per
  hour
• Development of personal skills one of these
  young ladies has significantly improved her
  skills in interpersonal relationships due to
  having control of her budget and being able to
  make choices

25
Stories from New Partnerships

• Communication One young man, who has Autism,
  has no verbal communication. His family were
  unable to work out his communication system.
  Using funding from his budget, an expert in
  communication spent 2 days doing intensive
  interaction with him. He and his family are now
  able to communicate with each other. This has
  reduced challenging behaviour because of
  frustration and family life is so much easier.
• Creative use of money Rather then employ 2
  staff members to support him in the water, a
  swimming instructor was engaged with a support
  worker. This resulted in the young man learning
  to swim, something he has wanted to do for many
  years.

26
Stories from New Partnerships

• Quality of life Emma had serious health
  problems, meaning that some days she was well and
  able to enjoy life and other days she was poorly
  and confined to her bed. Under the traditional
  system, if she was unable to give 24 hours notice
  to cancel her support, she lost it. This was a
  cost to the local authority.
• The activity which she enjoyed most, karaoke at
  the local pub, was a problem, because of the
  support workers shift system, which meant she
  had to leave at 9.45pm.
• With her individual budget she was able to employ
  her own staff for the days and times when she was
  well and this meant that she was able to stay
  until the end of the karaoke.
• One significant outcome was Emmas ability to be
  part of her local community and have her own
  circle of friends.

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Bid for Resources

• Following the success of New Partnerships there
  was a recognition that individual budgets could
  benefit individuals, the family and the local
  authority in terms of budget control. However,
  the learning disability service did not have
  sufficient internal resources to take it forward.
• With support from the Leader of the Council,
  Chief Officer and Assistant Chief Officer a
  presentation on Self Directed Support was made to
  WLGA and SSIA. This resulted in a successful bid
  to SSIA for additional resources.
• Funding for a one year Project Officer post and
  some consultancy provision was granted.

28
ImplementationAgreement from Council

• Approval from Council (Scrutiny and Executive
  Board) to implement Self Directed Support as the
  model for delivering social care to adults in
  Wrexham with a learning disability
• Regular updates through presentations to Members
• In Wales, Wrexham is regarded as the pilot
  authority for Self Directed Support

29
ImplementationStructures

• Steering Group a multi-disciplinary,
  multi-agency group with organisational influence
  to drive it forward
• Working Group people who, at an operational
  level, could develop guidance, documentation and
  processes
• Appointment of Project Officer on a one year
  fixed term contract
• Agreement with Paradigm to provide consultancy
  support
• Establishing the pounds per point for Wrexham

30
ImplementationPounds for Points

• Desktop exercise cross section of people with
  high, low and medium needs. Used RAS4
• Agree percentage investment (top-sliced budget)
  allows for new services and transitional
  payments. Members of our authority then agreed
  the percentage investment.
• Integrity check essential to get pounds for
  points set at level which does not cost authority
  any more money, but also allows for growth.
• Pounds for points may need adjustment and this
  can be done using the RAS 5 tool.

31
Implementation Training

• Training Community Learning Disability Team to
  work with a new system.
• Initially the training concentrated on the
  concept and values of Self Directed Support.
• Training involves the acceptance of the shift in
  power from the practitioner to the
  individual/family and the change in culture that
  this implies.
• As the system and processes evolve, additional
  training is provided to the team and full
  training to new members.
• Training is both formal and informal, as an
  informal drop-in session is held weekly to
  support practitioners.

32
Implementation Awareness Raising

• Awareness sessions for other stakeholder groups-
• Council Members
• Team managers in other areas of Adult Social Care
• Staff who provide back office support, eg.
  Finance, Audit, Contracts, Human Resources, Care
  Brokers, Commissioning Team

33
Implementation Support and Guidance

• Support and guidance for individuals and
  families-
• People interested in Self Directed Support are
  invited to a series of 3 training sessions, which
  cover the following topics-
• Understanding what Self Directed Support is and
  how it works
• Ensuring that people are aware of all the
  options, in terms of compiling support plans,
  staffing, creative use of funding and budget
  management
• Underpinning knowledge to enable families to
  compile support plans themselves if they wish to
  do so. Further help and support is available
  from the local authority or an independent broker
• Weekly drop-in support session available for
  individuals and families to progress their
  support plans

34
Implementation Work with Providers

• Providers
• Both in-house and external providers of services
  will be affected by the implementation of Self
  Directed Support
• Early in the process, Paradigm provided a
  training day to make providers aware of the need
  to adapt and change their businesses in the light
  of new demands in the marketplace.
• Attendance by the Project Officer at provider
  forums to update and inform of progress.
• Free places funding at external conference for
  providers by the local authority.
• Providers Fair to give opportunity for providers
  to engage with individuals and families and to
  showcase their unique selling point.

35
Implementation Changing Culture

• How do we make Community Inclusion really WORK?
• Set up a Community Inclusion Team (CIT) to
  address the following-
• Barriers to inclusion
• Lack of knowledge about whats available
• Resource An electronic interactive up-to-date
  database of all community activities, groups and
  organisations. Maintained by the Community
  Bridge Builder (CIT)
• Lack of appropriate support to engage in
  meaningful community activities
• Resource One to one support commissioned where
  appropriate through resource panel or SDS budget
• Resistance from community groups
• Resource Staff from CIT will engage in
  discussion with groups about their worries and
  fears and will support them to understand the
  positives of including people with disabilities

36
Communication Strategy

• Formal reports and submissions to committee to
  take project forward and to report on progress
• Distribution of minutes of Steering Group
  meetings
• Informal communication taking the opportunity
  whenever possible to talk about Self Directed
  Support
• Open days drop-in between 10am and 4pm to
  obtain information and an opportunity at the end
  of the day to hear a presentation from someone
  who has their own budget
• Media engagement good news stories to educate
  the public about Self Directed Support

37
Budgetary Considerations

• Financial profiling
• Early intention to select packages of support in
  order to keep a balance between high and low cost
  services and manage the financial profile.
• Effective use of funding streams-
• Should start with a benefit check
• ILF must be applied for where someone is eligible
  and this will be included in the indicative
  amount from Social Services
• Supporting People must be applied for if eligible
  and will be added on to indicative amount
• Health early identification of health needs by
  MDT and application for joint funding. Again,
  this will be added on.

38
Working Documents

• Process Flowchart
• A visual guide for practitioners to implement
  Self Directed Support
• Resource Allocation Questionnaire
• Simple tick-box, multi-choice questionnaire to
  assess how the persons disability impacts on
  their daily life
• Guide to Individual Budgets the rulebook
• What the money can and cant be spent on
• Simple and easy to understand
• Checklist for Resource Allocation Panel
• A tool for practitioners to use for panel
  submissions
• Risk Enablement Guidance Referral Form
• Process for Risk Enablement Panel for
  unresolved issues between supported person and
  Care Co-ordinator
• Individualised Budget Payment Agreement
• The agreement between the local authority and the
  person managing the budget

39
Top tips and things we now know make a difference!

• Index to Top Tips
• Strategic Considerations 1 4
• Being Person Centred 5 8
• Management Considerations 9 17
• Changing Culture 18 22

40
Top tips and things we now know make a difference!

• Support of senior management and council are
  essential to success
• Accurate pounds for points depends on a robust
  desktop exercise and contingency amount for new
  service users and transition. Dont feel that
  the historical data has to be perfect before the
  pounds for points are set.
• The Executive Board Report to the council should
  not state an exact amount for pounds for
  points, as the amount may need to be amended at
  a later date.
• Dedicated co-ordinator time. Introducing and
  implementing SDS cannot be done on the back of
  the day job. As implementation gathers pace,
  management recognise that a team of people is
  required if the pace and quality of change is to
  be sustained. We would suggest the following
  members of the team
• SDS Co-ordinator
• Assistant Co-ordinator (mainly to assist with
  writing support plans)
• PCP Co-ordinator
• Administration Assistant
• Additional Finance Officer time

41
Top tips and things we now know make a difference!

• A person centred culture is essential and if the
  authority has not already developed this, it will
  need to do so in order to implement Self Directed
  Support. This is a whole culture change where
  there is a transference of power from
  professionals to individuals and their families.
• Person Centred Planning is very helpful, as
  underpinning information for support plans can be
  incorporated and built upon. Although, a person
  centred plan is not essential for Self Directed
  Support.
• Encourage creativity by not providing a ready
  made list of activities or services for people to
  purchase.
• Good news stories for the media early in the
  process help to build awareness and confidence of
  SDS as a new way of allocating resources. There
  are two main messages that need to be conveyed by
  the media using real life stories. The first is
  an assurance that public funding is being spent
  responsibly and effectively to obtain value for
  money and the second is that individual budgets
  improves the quality of peoples lives.

42
Top tips and things we now know make a difference!

• Tenacity changing processes and culture is
  difficult. Climb every mountain!
• Communication is key. Take every opportunity,
  both formally and informally to communicate the
  message that Self Directed Support is the future
  of Adult Social Care. Dont make assumptions
  that professionals will automatically understand
  the concept.
• Target Setting Dont be over-ambitious.
• Wrexham set monthly targets for achieving SDS
  packages far too high 10 per month. In the
  early months, this has proved to be unachievable
  as in order to retain the ethos of Self Directed
  Support, it is essential to be led by the
  supported individuals. This time-frame can
  vary depending on levels of understanding and
  skills. Also, it is impossible to set up a
  perfect system immediately and time is needed to
  develop systems which suit the local situation.
• Being clear with all concerned that once the
  budget has been set, any services must be
  delivered within that allocation, unless needs
  change.

43
Top tips and things we now know make a difference!

• Self Assessment is for people who live in the
  community, not residential care. However, if a
  young person is in a residential college
  placement, Self Directed Support can be provided
  for college holiday support. The allocation of
  funding would be worked out pro-rata for the
  weeks they were not at college.
• It is very helpful to include key stakeholders,
  such as Finance and Audit in the Steering Group
  from the beginning of the process. This avoids
  having to change processes in order to
  accommodate audit and finance requirements at a
  later date.
• Make good use of more experienced authorities,
  learn from their mistakes and build on their
  successes.
• Engage a knowledgeable, reputable consultant to
  advise, support and be your critical friend.
• Accept that although you may wish to select the
  order in which people develop their individual
  budgets, this may not be possible. In Wrexham we
  wanted to keep a balance between high, low and
  medium cost packages in order manage the budget.
  However, Self Directed Support tends to grow in
  an organic way, with people coming forward who
  want to make significant changes in their lives
  these will be your good news stories!
  Eventually, we decided to go with the flow and it
  seemed to work.

44
Top tips and things we now know make a difference!

• Personalising and modernising in-house services
  is key to ensuring that individuals have real
  choice and control when purchasing their support,
  for example-
• Training people who receive support to quality
  check services. In Wrexham a team of people
  receiving supported living, quality check each
  others services in line with the Reach
  Standards.
• Training individuals to recruit and select their
  own staff. Training includes Equal Opportunities
  legislation, interview questions and techniques,
  evaluating responses.
• Community inclusion maximising opportunities
  for people to truly integrate into their own
  local communities.

45
Top tips and things we now know make a difference!

• Be aware that people may not wish to be directly
  responsible for, or involved in, the writing of
  their support plan, the management of the budget
  or the management of the service. Independent
  brokers can be employed by the individual to
  assist with all these tasks.
• Compliance with the Corporate Project Management
  process. This could have been viewed as having a
  negative impact, but was actually a positive
  experience. The Corporate Risk Assessment
  meeting provided people with an opportunity to
  voice all their concerns and fears about risks to
  the authority. Risk reduction strategies were
  discussed, including identification of current
  control measures and how the residual risks would
  be managed.
• Currently Self Directed Support sits outside
  traditional Social Services / Adult Social Care
  systems, however learning to engage with these
  tried and tested Corporate systems, brings a
  validity and strength to the new processes.
• In order to successfully implement Self Directed
  Support, we believe it is important to engage
  with peoples intellects and their emotions.
  Self Directed Support has a high value base and
  there is a need to understand how the system
  works, but also to engage with the life changing
  experiences of people who use Self Directed
  Support. Use powerful stories.