Integrated Care Think Tank

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• Integrated Care Think Tank
• June 2007

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• Set up in 2003 as government-community social
  enterprise - will be established as independent
  charity by the Autumn 2007
• Pioneered concepts of Self-Directed Support and
  Individual Budget (Phase One, 2003-2005)
• Today works across all social care groups -
  adults children
• 95 local authorities have subscribed as members
• 1560 people using Self-Directed Support (Phase
  Two, 2005-2007)
• 10 local authorities committed to total change
  (Phase Three...)
• Leading website on Self-Directed Support
  www.in-control.org.uk
• Open source community - working with over 20
  franchised partners

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Independent Living
Institution
Care
Citizenship
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Social Care Today

• Current system of social care doesnt work - its
  broken
• Its broken because power, control and
  responsibility is all in the wrong place
• Decisions are in the wrong hands - too far away
  from the person
• We need a system that treats people as citizens

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Citizenship

• People needs to be in control of their own life
• People flourish as part of families and
  communities
• People are entitled to support
• And should have as much control as possible over
  how they live

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What is the locus of integration?
Social Care
NHS
Education
Local Services
Housing
Tax Benefits
Transparency of rights, service and community
options... services facing the right way
State provision
Non-state provision
Community
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in Controls Model of Self-Directed Support
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IBs changed my thinking! Its about getting the
most out of your life. Living, instead of
existing!" Disabled Person, Essex
...life is going to change for my son, my
husband and I. Its going to make a mammoth
difference. Mum, Essex
Many practitioners and Team Managers feel that
this is what real social work is about... its
what I trained for J. Goldingham, West Sussex
We ask individuals and families what they want
and its our job to go and find it... and
generally people dont ask for unbelievable
things... Doreen Kelly, Partners for Inclusion
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Possibilities for Staying in Control

• Pooled funding
• Bed-blocking
• Over-medicalised interventions
• MH reform
• Therapy services
• People with complex needs
• Continuing Health Care
• GP based services, practice-based commissioning
• Outcome-based commissioning
• Payment by Results
• Jan Keanes research?

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Self-Directed Support
The Commission for Social Care Inspection 2004 -
MORI Poll found that most people want to choose
their social care - three-quarters (73) say a
person requiring social care should be able to
choose their services and be given money by the
government or council to pay for them, rather
than have the government or local council decide.
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Complicate
ILF Mark 1
Too Expensive
Self-Directed Support Sensible, Legal,
Affordable and Universal Designed to put
EVERYONE in control of their own life
ILF Mark 2
Ilegal
Over-regulate
Direct Payments
Just for Some
Limit Eligibility
European Systems
Doesnt fit
Professionalise
Self-determination (USA)
Threatens Us
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Individual Budget
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Empowerment vs. Assessment
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Co-produced Self-Assessment
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Support Brokerage
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Degrees of Control
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Individual Service Fund
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• Self-determination - Helens Mum
• Direction - Janes Art Class
• Money - Margarets new family
• Home - Patricks Trust
• Support - Keiths personal trainer
• Community Life - Gavins season ticket

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• Are you happy with your support?

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in Controls learning

• Self-Directed Support seems to lead to better
  support and happier people
• Self-Directed Support seems affordable
• Many social workers feel that Self-Directed
  Support is allowing them to return to the values
  and skills that made them join the profession
• Flexibility of funding is critical - we do not
  know - in advance - what good support looks like
  - so we must not fetter the discretion of those
  who know best
• Self-Directed Support implies a radical re-think
  of roles, funding, regulations and policy... and
  some people are ready to try

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data excludes cases of new or changing need and
compares individual costs with actual or with
prevalent market costs
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Structural inefficiency

• Pre-committed resources (30 waste)
• High transaction costs (25 plus)
• Prices driven by providers (profit levels growing
  from 5 to 25)
• Enormous social costs

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Sustainability of Self-Directed Support

• The right money
• To the right person
• Maximum choice flexibility
• Minimum burdens and waste
• Clear entitlements
• Productivity
• Community connections
• Personalisation satisfaction

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Current Inequity
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Shift to Self-Directed Support
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Managing transformation