Managed Personal Budgets: Myth or reality?

Transcription

1 Improving the evidence base for adult social care practice Managed Personal Budgets: Myth or reality? Parvaneh Rabiee, Kate Baxter, Caroline Glendinning SPRU, University of York SSCR Annual Conference LSE, 14 May 2012

2 Structure of the presentation Context and the rationale for the study Aims and objectives Design and methods Commissioning changes Support planners roles Summary and conclusions 2

3 Context and rationale for the study Mechanisms for managing Personal Budgets Cash direct payments Managed personal budgets Local authority-managed Provider-managed (known as Individual Service Funds) Most older people have managed PBs Most managed PBs used for home care 3

4 Aims and objectives School for Social Care Research Explore factors affecting delivery of personalised support to older people who opt for Managed PBs Objectives: Identify innovative practices Explore support planners roles in shaping PB holders expectations and requests Explore home care provider responses to changes in contracts and service user requests Examine older people s experiences 4

5 Design and methods 4 stages: School for Social Care Research Interviews with commissioning managers Focus groups with LA support planners Interviews with agency managers Interviews with older people using managed PBs/ISFs 3 LAs involved: Leading edge in increasing choice for people using managed PBs Urban and rural authorities 5

6 Focus of this presentation First two stages: Commissioning managers Support planners Health warnings Generalisability Have we got the most innovative sites? Half way through the project 6

7 Market development School for Social Care Research Identifying gaps in the market and encouraging development of services to fill those gaps Different approaches LA-based Market Development Officers Innovation Funds However: Prioritising more choice for DP users 7

8 Contract changes Framework Agreements: School for Social Care Research LA will only purchase care from providers on the list No guaranteed minimum level of business One LA still uses block contracts and some spot contracts Trade off between maintaining viability and increasing choice Increasing the number of providers to encourage use of DPs 8

9 Incentives No incentives/rewards in contracts to: Encourage more personalisation Hold budgets for users (i.e. ISF) All are sole providers no subcontracting 9

10 Support planners - Knowledge of roles & expertise All LA staff Basic training on personalisation Little change in activities Encourage people to think outside the box Balancing knowledge of services with creative thinking 10

11 Choice of providers School for Social Care Research Brokers (using outline support plan) find providers on the Framework Lack of availability of services/choice In most cases, only one provider has capacity to respond to broker request In rural area, choice often comes down to location Sometimes use two or more providers - not indicator of choice 11

12 Choice in the content of services Little influence other than specifying user needs and preferences (e.g. preferred time, male or female worker) No guarantee preferences are met Where services not meet assessed needs/ preferences: Negotiations between support planner, service user and provider a lengthy process Will change the provider, if possible Service user will put up with it 12

13 Summary and conclusions Shift from block to Framework contracts - however: Limited choice of providers Staff training not geared towards new role as support planner Thinking outside the box but having to fit people into boxes! Providers having greater role in detailed support planning but no incentive to encourage choice Policy and practice being driven by getting more people onto DP How far are these likely to increase levels of choice and control for people using managed PBs? 13

14 Personalisation of Home Care for Older People Using Managed Personal Budgets 14