Brokerage & Advocacy Review. February 2010

Transcription

1 Brokerage & Advocacy Review February 2010

2 South East Brokerage & Advocacy Review February Table of Contents 1. Introduction and context Independent Brokerage Independent Brokerage in Oxfordshire County Council, Brighton & Hove City Council & Hampshire County Council National Models Internal Brokerage Internal Brokerage in Reading Borough Council, West Berkshire Council and Bracknell Forest Council Brokerage through Voluntary and Community Organisations Portsmouth City Council Brokerage Initiative Peer Brokerage Peer Brokerage in West Sussex County Council National Models Advocacy Services Research Methodology Appendix 1: Hampshire Support Brokerage Service Appendix 2: Portsmouth City Council Learning Exercise Information Appendix 3: Oxfordshire Draft Specification for Independent Brokerage Appendix 4: Westminster Brokerage Specification... 40

3 South East Brokerage & Advocacy Review February Introduction and Context This research is part of the Joint Improvement Partnership (JIP) programme of support for South East authorities on transforming adult care, developed based on the key areas of support identified by authority transformation leads. The research is funded and delivered by Improvement and Efficiency South East. The requirement for the research, defined within the JIP programme plan is: Undertake a review of the different forms of Brokerage and Advocacy being developed against developing good practice and the benefits/disbenefits and cost implications of each approach. The research aims to help authorities save time and effort by summarising the learning and good practice from other authorities and providing simple useful links to more detailed support resources and information. There are four areas of Putting People First on which councils and their partners should focus to help make sure services become more personalised and to get the right results for citizens. Putting People First is clear that these areas link together. To make sure change is successful all of them have to be in place to ensure people can have the right quality of life. The third part of Putting People First is about self-directed support which is where Brokerage and Advocacy services will play an important part. Self-directed support means having services available to meet people s needs rather than people having to fit in with the things on offer. People who need support should be able to choose who provides that support, and control when and where the services are provided. The right information and advice needs to be available to help people decide. Some people will need extra help to negotiate their support and may need advocates to help them. It is important to be safe, and guaranteeing safety will be an important role for the local council and local community. However, it is also important that people can take responsibility for themselves and that councils and other advisers are not limited in their advice about what is possible. There is a guide for local councils to use which make sure this can be done safely and that people can be supported to make decisions - Independence, choice and risk: a guide to best practice in supported decision making. Success in this area of Putting People First would mean people in the community who need support and their families and carers feeling empowered to come up with flexible solutions to meet their needs, individually or collectively. They would understand what is available and be confident the services available to buy were suitable, safe and reliable. People feel they have a life rather than a set of services.

4 South East Brokerage & Advocacy Review February The Department of Health (DH) have agreed with ADASS and the Local Government Association (LGA) that there are 5 key priorities during this first phase of transformation (by April 2011), Brokerage and Advocacy services enable delivery against 2 of these priority areas, for which the target milestones are: Information and advice Local commissioning April 2010 October 2010 April 2011 That the council has put in place arrangements for universal access to information and advice. That every council has a strategy in place to create universal information and advice services. That councils and PCTs have commissioning strategies that address the future needs of their local population and have been subject to development with all stakeholders especially service users and carers; providers and third sector organisations in their areas. These commissioning strategies take account of the priorities identified through their JSNAs. That providers and third sector organisations are clear on how they can respond to the needs of people using personal budgets. An increase in the range of service choice is evident. That councils have clear plans regarding the required balance of investment to deliver the transformation agenda. That the public are informed about where they can go to get the best information and advice about their care and support needs. That stakeholders are clear on the impact that purchasing by individuals, both publicly (personal budgets) and privately funded, will have on the procurement of councils and PCTs in such a way that will guarantee the right kind of supply of services to meet local care and support needs. This report looks at different models of brokerage services being provided in the South East, the definition of these models and the benefits and disbenefits of these models. No examples could be found in the south east of bespoke advocacy services developed as part of Adult Care transformation. However the report contains a section on advocacy services that provides links to resources and national examples.

5 South East Brokerage & Advocacy Review February Support brokerage, as a term, has been used in some social care services over the last twenty years or so. In the context of self directed support, it has become fairly commonly used to describe a range of help for people with a personal budget. A definition is important as people need to have a common understanding when language is used. Support brokerage has a number of functions which imply an array of activities or tasks. It is best seen and understood by this set of functions, rather than seeing brokerage encapsulated within a role of a support broker. Support brokerage needs to be understood as inherently community based. The key functions of brokerage include: Finding out what is available Exploring what is possible Providing information (signposting) Giving technical advice Encouraging and developing informal support Coordinating support and resources An important unresolved issue to do with brokerage and advocacy services is how they are to be paid for (is the cost deducted from personal budgets or is it a service overhead) and whether they are made available to self-funders. Local Authorities recognise they need to find a mechanism for charging but it is not yet known how this will be done or when. It is likely that a phased approach to the introduction of charging will be required and it is understood that this will need to be well planned.

6 South East Brokerage & Advocacy Review February Internal Brokerage This service model is delivered in house by the Local Authority, the brokers are employees of the Local Authority and the service will be managed internally Internal Brokerage in Reading Borough Council, West Berkshire Council and Bracknell Forest Council A number of Local Authorities in the South East have opted to keep their brokerage services internal. Each of these 3 examples are Care Manager led and were the same as or a slightly adapted version of what was already in place before Putting People First. The model is based on the Care Manager completing a support plan with a service user and either carrying out brokerage themselves within their Care Manager role. Other slightly different versions of this model have resources to carry out the broker function on behalf of the Care Manager. For example, in Reading the Care Manager writes the Support Plan and provides the Broker role also for the service user. In West Berkshire, Care Managers are allocated 10 hours per working week each to provide Brokerage, not to people on their case load necessarily but to any Service User who is engaging with the Brokerage service. This is thought to cut down on waiting times of Service Users, allow for Care Manager sickness, and allow for better understanding of all services available in the area by all Care Managers. In Bracknell Forest, the Care Manager writes the support plan and passes it on to dedicated brokers that sit within the Care Managers team to provide brokerage service. This allows for joint working between the Care Manager and Broker but also allows the Service User to discuss the Support plan and the way they would like their needs met with somebody other then their Care Manager. This is thought to encourage the Service User to think differently about the Care they are provided and investigate different options. Impact on cost No comparison can be made between today s cost and the cost before Putting People First was in place as no additional cost has been added by adapting the service slightly inline with Putting People First. Monitoring Arrangements All monitoring of service delivery and performance is done internally; all of the above services are integrated into the Care Management teams and are line managed in the same way.

7 South East Brokerage & Advocacy Review February Service Targets Reading s target number of service users within their Putting People First implementation plan was to reach 40 active service users utilising the brokerage service by February With current numbers at 34, they hope to exceed this target. West Berkshire are currently phasing in implementation of personalised budgets and currently have no targets on numbers of service users they want to be working with and do not plan to performance manage themselves against this until phase 2 of implementation is completed. In this phase, their brokerage service will include additional services such as financial support and advice and a support system for the line management of Personal Assistants. The details of this are not yet completely formed and although these additions are not brokerage functions they will be delivered alongside brokerage services and for future recruitment will be included in the job functions of some brokers. In Bracknell, no targets have been set as no changes have been made to the Brokerage service as part of Putting People First. The service has not changed and is currently at full capacity. Key Lessons Learned It was felt by all three example Local Authorities that spending time and some resources investigating and mapping the current brokerage provision in place within an authority would make financial savings. All three authorities considered commissioning additional services for Brokerage in response to Putting People First prior to spending time looking in detail at the current provision which they then found to be adequate. Benefits to Service Users Monitored and regulated by the Local Authority. Better joint working between Broker and Care Manager. Feedback from service users when involved in modelling of services in both West Berkshire and Reading was that they felt safer with Local Authority services. The disbenefit to service users of keeping the brokerage service in house, according to service users in Reading, was the perceived idea that they had limited choice and freedom as no changes had been made. Reading thought that this could be due to staff attitudes within that service because change has not affected them as much as others and they have not necessarily embraced the benefits and changes they are expected to make in terms of informing people about their choice.

8 South East Brokerage & Advocacy Review February Benefits to Local Authority It was felt that Putting People First caused these Local Authorities to look at and understand the brokerage service that was currently in place. By doing so it has allowed them to make minor changes to this service instead of having to commission a new service saving them both resources and budget. Working with the staff within these teams helped to build team morale. A good level of training, consultation and communication between transformation leads and staff helped to achieve easier transition where required as staff felt informed and empowered. It also led to identification of volunteer champions of Putting People First within the front line workforce, which it is hoped will have a positive impact on some of the future, bigger changes planned as part of Putting People First.

9 South East Brokerage & Advocacy Review February Independent Brokerage This service model is delivered externally and not connected to any Local Authority. The brokers are not employees of the Local Authority and the service is managed externally. Independent Brokerage should allow service users the opportunity to be provided a brokerage service that is separate from the Local Authority and service providers Independent Brokerage in Oxfordshire County Council, Brighton & Hove City Council & Hampshire County Council A number of Local Authorities in the South East have opted to use external independent brokers on a spot purchase basis alongside their internal brokerage service. The model is based on a pool of 8-10 independent brokers providing this service. After the service user budget has been set, referrals are made from the Care Management Team to an independent broker who then creates the support plan with the service user and sends it back to the Care Management Team for agreement. This is the same for both Oxfordshire and Brighton & Hove with the only difference being the service offered to self funders. In Oxfordshire, the same service is provided free of charge to self funders as is their internal brokerage function see Appendix 3 for a copy of their draft specification. Brighton and Hove offers a free internal brokerage service to all service users including self funders. However, if a self funding service user chooses to use external brokerage they are expected to fund this themselves. The Local Authority will help them to arrange this service and discuss their options with them. Another authority that has chosen Independent Brokerage is Hampshire County Council. Hampshire County Council has worked with Age Concern to develop an Independent Brokerage service, see Appendix 1 for details of the service specification. Impact on Cost In Oxfordshire the service is currently paid for from the Care Management purchasing budget and the Age Concern funded pilot project funding. Monitoring Arrangements Current monitoring arrangements are via Service User feedback and support plan feedback from Care Manager. The Care Manager will flag if they feel that the support plan is not to the standard required and discuss this with the Service User. In Oxfordshire future User Led Brokerage service will be part of the Care Management team and all monitoring of the service will happen via the Care Management team.

10 South East Brokerage & Advocacy Review February Service Targets In Oxfordshire, upwards of 160 service users are benefitting from the Brokerage service. The future target is that 100% of service users given Direct Payments will be dealt with via the brokerage service by Brighton & Hove have not set targets for this service yet, however they currently have 48 active service users using their brokerage service and they estimate that around 15 of those are currently using external brokers. Key Lessons Learned Staff resistance to change has been an ongoing issue throughout this process for each authority. This was an anticipated problem before change was made but was not expected to create as much difficulty as it did. It was and is felt by staff that, although they were fully consulted on the changes, they were not kept well enough informed of the progress of change. It is felt that better planning and a staggered approach to change would have been a better option for all staff; both those effecting change and those being affected by change. In Oxfordshire the future plans for change will include regular bulletins to all staff and a change newsletter online for members of staff to access. It is planned to also have a drop box set up for staff to ask questions about change that will then be responded to either directly or through the online intranet page. Brighton & Hove lost a key member of their project staff and due to this some of the staff communication suffered. Benefits to Service Users Independent brokerage offers the following benefits to Service users: Independent Brokers have more allocated time to the service users they are working with which enables closer contact with clients developing person centred services. Due to the service user having more choice not only with the different types of brokerage services available but also being able to choose which independent broker they want to use this means that the service can be better tailored to individual need and is not service led. Benefits to the Local Authority This type of service follows Independent Living principles and provides better outcomes for clients as it allows the service user to choose not only the services they purchase but the service they use to help them choose the right services. It is felt that, although spot purchasing of independent brokers can be expensive, balanced against the time gained by employed staff such as Care Managers this can be a more cost effective model.

11 South East Brokerage & Advocacy Review February National Models With increased choice being a priority for most Local Authority Adult Social Care departments, many National Local Authorities are offering an independent brokerage service or have plans to do so. London Boroughs Kensington and Chelsea and Tower Hamlets have chosen Independent Brokerage as their only Brokerage service, however these services are still in planning stages and have not yet been implemented. Westminster has chosen to commission an independent Brokerage service that will work alongside their existing internal service, for details of their independent Brokerage service please Appendix 4. West Midlands Improvement & Efficiency Partnership have been involved in a Project in Herefordshire Care Broker- Building Independent Brokerage Capacity in Herefordshire for details of this project use the link provided.

12 South East Brokerage & Advocacy Review February Brokerage through Voluntary and Community Organisations An alternative approach to brokerage is targeting Voluntary and/or Community Organisations to provide this service; this is an approach that Portsmouth City Council have taken Portsmouth City Council Brokerage Initiative Portsmouth City Council is currently undertaking a learning exercise to facilitate the implementation of self directed support. They are seeking expressions of interest from voluntary and community organisations for a share in the allocation of funding to deliver support brokerage. A total budget of 100,000 is available to be shared between up to 5 organisations. This funding is short term for 1 year only from 1 December 2009 to 31 November 2010, specifically to test out different models of support brokerage. Funding is planned to be a combination of an up-front payment for training and general advice, payment for attendance at project meetings and payment for Support Brokerage on a spot purchase basis. Payment for support brokerage will be made on a spot-purchase basis based on the numbers of hours delivered at a rate of 15 per hour. The rate of 15 per hour includes staff time and on-costs associated with support brokerage either devising the support plan and/or assisting someone to put the plan into operation. It also includes administration costs. There are a number of expected outcomes from this learning exercise. Predominantly it will provide evidence, good practice and lessons learned to enable Portsmouth to plan support brokerage services for the future. More information on this is provided in Appendix 2.

13 South East Brokerage & Advocacy Review February Peer Brokerage A Peer Brokerage service model can sit alongside another type of brokerage service or independently of other services. Peer Brokerage is a service that is delivered in a formal and planned way by past or present service users for service users. A simple definition for peer support is activity that refers to people that are providing supportive, emotional and practical help to one another Peer Brokerage in West Sussex County Council When implementing Putting People First, West Sussex County Council drew on the knowledge gained during research done in 2006 in partnership with Carers UK and through discussion found that when looking to remodel the Brokerage service in West Sussex it would be important to include Peer Brokerage within the service. West Sussex felt that a Brokerage service based purely on peer support was not a viable option and could put their service at risk. To provide a fair peer brokerage service it is necessary to match service users with the correct peer to provide the brokerage and this was felt to be an impossible task since no peer could be given a paid role on this basis so could not be called upon at anytime leaving the service very vulnerable. Whilst it was understood that this service was going to take a lot of coordination and initial set up resource, it was felt the benefits would far outweigh the disbenefits of providing this resource. The following was put in place to support the peer brokerage service and provide this service as a choice to service users across West Sussex: A regular peer forum Workshops set up to assist training; information and consultation Buddy system to support establishment of a peer guidance and mentoring Direct Payments obligations were set including 1:1 support. Personal Assistant (PA) management assistance Facilitation of training for PAs Monitoring Arrangements This service is part of the Internal Care Manager Led Brokerage service. All monitoring of this service and the service user satisfaction is through the Care Manager. All service users and peers receive a 1:1 session with the Care Manager to discuss the Brokerage service required and the Care Manager manages expectations of the service. Most Service Users, if they choose to use Peer Brokerage, have a peer that they would like to use. Very often this works and the relationship between the service user and the peer is already well established.

14 South East Brokerage & Advocacy Review February Once a peer has become involved and has engaged in the training provided they most often enter a bank of peers that are happy to be called upon to be matched with a service user that chooses to use the Peer Brokerage service that does not have a peer in mind already. All training and brokerage work undertaken formally by a peer broker within this service is recorded via West Sussex HR department. Service Targets Currently around 26 service users are being worked with by peer brokers, the brokerage service as a whole will have a target number of service users to enter the brokerage service. No particular service user group is being targeted to use the Brokerage service although it is acknowledged by West Sussex and across the region that brokerage services are primarily geared towards Older People since they make up the largest percentage of the service user population. West Sussex has a high number of service users currently choosing to undertake their own brokerage, hence the target has not yet been set and it has been decided that more promotion/information literature needs to be produced in a user friendly way first as it is felt that this is the main reason the Brokerage service overall is not being fully utilised. Key Lessons Learned A view was taken initially that most promotion of the service would need to be done internally. It was thought that it was most important to promote to staff that were likely to be referring into the Brokerage service and to external partner agencies that would also be making referrals into the service. Work was done mainly with PCT, Adult Services Departments, Citizens Advice and Providers. Team meetings were attended, letters sent, referral forms and information leaflets were also sent. The promotions done were felt to be very successful and referrals into the service and the knowledge of the service by other professionals were higher then expected. Promotions to new and existing service users was done via Care Managers, Care Managers had been fully informed of what the service would be and what it would be offering via Line Managers, Team meetings and staff consultation. However, the message to the service users was not as strong as was hoped, which led to a lack of understanding from service users. West Sussex engaged in some service user feedback regarding the lack of uptake from Service Users compared to the past Brokerage Service, this was done via Care Managers and brief feedback questionnaires Feedback received showed Service Users did not fully understand the changes that has been made and did not feel the changes had been explained to them by Care Managers correctly in some cases. West Sussex is currently working on new information leaflets for Service Users and are currently in the first round of Staff Information Sessions, these information sessions are not being held as mandatory however all front line adult services staff have been encouraged to attend.

15 South East Brokerage & Advocacy Review February Benefits to Service Users Peer support overall encourages both those being helped and the helpers to develop personal and social skills, such as communication skills; improving selfesteem; learning to negotiate with one another and others over areas of conflict; and learning to ask for help and support. It gives people the opportunity to experience different roles and responsibilities, and to learn leadership skills and team working. The service that is being delivered by West Sussex offers the following benefits to service users: Opportunity for services users and peers to engage in training and personal development. Understanding from Peers that is not always possible with other services Extended choice of Brokerage Service Benefits to Local Authority A choice of brokerage services is made available by offering this service in addition to an internal brokerage service. However, the disbenefit of this service is the cost and additional resource of establishing and running a new service National Models Nationally only a limited number of Local Authorities have a Peer Brokerage model in place as Peer Brokerage is seen to be the most difficult model to establish and sustain. Of the Local Authorities that were contacted nationally as part of this research, two of them were running Peer Brokerage services: Leeds City Council run a Peer Brokerage service as part of there internal service and Kings Lynn and West Norfolk Borough Council support an external Peer Brokerage service.

16 South East Brokerage & Advocacy Review February Advocacy Services There has been an increased emphasis on advocacy in recent government legislation and policy including Putting People First. Action for Advocacy aim to ensure the advocacy sector is informed of current policy and legislative developments and can influence and raise awareness of advocacy within policy. They have carried out a number of case studies nationally and, although none have been carried out in the South East region, the case studies and research show a very similar picture in this region. Although there seems to be a lot of advocacy currently taking place in each local authority most of it is very low level advocacy which is provided alongside information and advice services. Brokerage services are also providing advocacy but this is not being carried out in any formal way and is not being identified as a service being offered within its own right. The cross-government Independent Living Strategy (ILS) published in This takes a life course approach, from transition to adulthood through to very old age, the strategy s aims include giving greater choice and control over how support is provided and have greater access to leisure, transport and the opportunity for participation from families and communities. The strategy is jointly owned by six government departments including - 'Putting People First. The Office for Disability Issues (ODI) is leading on some key commitments that address issues that were raised as important including brokerage and advocacy. The London Borough of Richmond upon Thames, Southampton City Council and Essex County Council have worked with three local user-led organisations. This was to demonstrate how to bring about changes in the assessment and care management process, although these pieces of work are not specific to Advocacy it is expected that some good learning around advocacy services will come from this work. These initiatives were developed following a scoping study to identify potential candidate sites and the main activities needed to deliver the changes required. Research has been commissioned by ODI to assess the need for, and the costs and benefits of providing, independent advocacy. The Norah Fry Research Centre at the University of Bristol is carrying out this work, which has two stages. Firstly, a literature review will outline the evidence that currently exists about advocacy in the four situations. This will highlight where there is insufficient information to draw conclusions on the needs for, and cost and benefits of, advocacy. Stage two will build upon the literature review. It will identify what action is required to establish a more complete picture of the benefits and costs of advocacy, this report was due in autumn 2009 but has not yet been published.

17 South East Brokerage & Advocacy Review February Research Methodology Phase 1 All 19 South East Local Authorities were given the opportunity to input into this research. The following authorities kindly allowed their services and activity to be used as examples: West Berkshire Council West Sussex County Council Portsmouth City Council Bracknell Forest Borough Council Oxfordshire Council Reading Borough Council Hampshire County Council Other organisations were also identified as key sources of information and were contacted as part of this research, these organisations were: ODI Independent living and learning sites scoping study, Independent Living Strategy Team/ Norah Fry Research Centre cost benefit analysis. IDeA, Kathryn Elliott, Children's and Adults' Health and Cultural Services Information, Advice & Advocacy Report ADASS - Veronica Jackson, Co-Chair ADASS Personalisation Network ADASS 3 rd Sector Sub Group Department of Health Integrated Care Networks Department of Health PPF Delivery team Peer Support Recommendations Action for Advocacy Southampton Centre for Independent Living - Advocacy and Brokerage Project Phase 2 34 questions were asked in relation to Brokerage and Advocacy of each Local Authority that was interviewed during this research. The questions were asked during face to face interviews with the appropriate lead in this area as identified by Transformation Leads. Phase 3 Following interviews with Local Authorities, research was carried out using the internet and information from various Local Authorities that was sent directly. The interview questions and answered form the majority of the research. Contact Information Carly Hedges Improvement & Efficiency South East T: E: carly.hedges@southeastiep.gov.uk

18 South East Brokerage & Advocacy Review February Appendix 1: Hampshire Support Brokerage Service Age Concern Support Brokerage Service In , eligibility for funding in some Hampshire became for people with substantial or critical needs only. Charges for self-funders increased. The majority of people in Hampshire are self-funders. Following research by Hampshire County Council, it became clear that brokerage and personalisation were to become mainstream. Age Concern, which already ran a Direct Payments Support Service under contract with the Local Authority, presented a proposal to the Council to run a Support Brokerage Service as a pilot. The proposal was accepted and Age Concern was commissioned and fully funded to provide this pilot service, starting in March Due to Local Government Reform the service is now funded to the end of March The service aimed to support a move towards making an independent brokerage service available across Hampshire and towards Individual Budgets; to increase the numbers receiving Direct Payments; to stimulate the provider market by promoting self directed services; to work within the framework of the National Brokerage Network; to meet Practice Guidance of LAC(2001)32, Fairer Charging Policies for Home Care and other non- residential social services by providing a service to those older people deemed to fund their own care; and to meet the requirements for non-residential services as required under section 17 of the HASSASA Act 1983 to provide more than just information. The County Council has run a Self Directed Support pilot since April 2008, with Age Concern involvement. A report on findings and the implementation of recommendations is to be given to the two new Unitary Authorities which take over from 1 st April How support brokerage will be funded is part of the plan, and several options are available to the two new Unitary Authorities. In line with this, the service has now been opened to clients, via internal referral, who may not want to access via a care need assessment by Social Services. Funding and charging options are also being investigated in readiness for future changes. Scope of service Service recipients: Older people (65+) who have been assessed by a social worker as needing non-residential services, as being self-funders who are deemed able to pay for their own care and who do not want a Social Worker involved Service provided: Referral to the service via Social Services, following an assessment of care needs which is forwarded to the service. Age Concern is a partner in the

19 South East Brokerage & Advocacy Review February Single Assessment Process (SAP) and a license holder under SAP, allowing access to assessment forms and to give feedback to statutory services online. Home visit from Support Broker to discuss what client wants, and to clarify needs and expectations. Assistance with preparing and costing a personal support plan, arrange and implement support plans, monitor and review the support package as instructed by the individual. Support may include helping to find carers, budgeting, advice and assistance on keeping records, employment law, health and safety, tax and National Insurance, payroll, providing a safe environment for meeting and interviewing prospective carers. Brokers also help build networks, promote choice and control, and tap into local networks and funding opportunities. Brokers each cover a limited geographical area, enabling them to become very familiar with what is available in their own local patch. Monitor and review of package of care and support on an individually agreed basis. An initial review takes place after six weeks with follow-up reviews as necessary, but at least annually. Response to referrals within five days. Where a client is being discharged from hospital, the social worker may complete the care assessment and the care plan> The Support Broker then arranges care in line with this information to enable the client to return home as quickly as possible. Once the client is at home, the Support Broker visits to confirm care arrangements and make amendments as instructed by the individual. As clients who are self funding are not subject to the Delayed Discharge Act, Social Services cannot be charged by the NHS for any delay in discharging them to a safe home environment. Anyone coming through to the service before an assessment of need has been carried out is referred to social services for a care assessment, with their consent. Benefits to service users Increased opportunity for people to define their own support needs Access to ongoing support Easy access to other AC Hampshire services such as: Advocacy, Information and Advice, Benefits Advice and Mentoring service (assistance with managing financial affairs) Regular monitor and review of package of care and support monitored on an individually agreed basis, according to their needs, wishes and personal circumstances. Ms A, 92, lives in an urban area. She was referred by the Rapid Response team, having been in hospital followed by respite for about 3 months before returning home with support from Rapid Response. Rapid Response s 6 week period of care was coming to an end and Ms A wished to continue care on a private, self funded basis.

20 South East Brokerage & Advocacy Review February Through the Support Brokerage Service Ms A was able to tailor a care and support package that she felt met her care needs and assisted her to retain her level of independence. Initially, Ms A wanted her care package to remain the same as she could not cope with too many changes. It was arranged for a care agency to take over the 4 calls a day at the same times, and for hot meals to be delivered every day. Ms A was much more settled by the 6 week review and wanted to regain some independence. He lunch and tea calls were cancelled. The Meals on Wheels were reduced to 3 days, with frozen meals the other days to increase the choice and variety of meals. This provided Ms A with more independence to get her meals herself when she is ready for them, but without having to stand and prepare a full meal. Ms A mentioned that, every Saturday, she sees her neighbours come back from the fish and chip shop and how long it had been since she had had fish and chips. The Support Broker spoke to the neighbour who agreed that they would get some fish and chips for Ms A on Saturdays. It was also agreed a care agency worker would escort Ms A once a week to the local garden centre or other place of interest as Ms A is unable to go out without someone taking her in the wheelchair. Ms A has no family who are able to do this for her. Relevance to government objectives and local/national targets 3 of the social care outcomes in Our health, our care, our say White Paper 3 of the core elements of the vision for a reformed care and support system Addresses Putting People First / Transforming Social Care priorities by supporting self-funders and providing access to integrated services Service outputs / outcomes March February referrals received during the first 12 months in operation (average monthly referral rate: 23) Assessment / evaluation of the service Full review and evaluation procedures are built into the project. Hampshire County Council carried out an evaluation of the service which was reported on internally. Various methods were used to gather information which took into account comments made at a number of focus groups held across the county with Social Workers, internal statistics and Age Concern s analysis report which was carried out after 10 months. The service is registered on the National Brokerage Network (NBN) which was set up to act as an information exchange and an authoritative voice for

21 South East Brokerage & Advocacy Review February the development of brokerage as part of the in Control initiative for selfdirected support. Sustainability and costs Provided an immediate (within 3 months) and comprehensive independent brokerage service by building on the structure of the existing Direct Payments Support service Bank of existing staff with robust knowledge base and expertise were able to recruit and train new staff quickly Staffing: 1 full-time Co-ordinator, 6 Support Brokers (4 full time equivalents) and 1 Support Officer (full time, job share) The proposal was for a comprehensive and direct provision with capacity to meet demand as currently assessed at the time of submitting the proposal, i.e. 400 self-funders and up to 30 new cases each month. Added value to clients of having access to other Age Concern services. An expectation of the contract was that the costs detailed would be subject to re-negotiation at any point if numbers fluctuated by 10% either way or if it became evident that the 5 hours average allocated per case is found to be too high or too low. Developments The Direct Payments Support Service for those under 65 years is provided by the Hampshire Centre for Independent Living (CCIL). Age Concern and CCIL work together to provide a consistent approach to the support services provided. Existing research shows that one of the frustrations in ensuring successful provision of care using Direct Payments and Support Brokerage is recruitment of Personal Assistants/Carers. A recent partnership venture is the Hampshire PA Register which was launched in June 2008 (see The PA Register is an on-line, easy access service owned, copyrighted and run by AC Hampshire and CCIL who act as facilitators only. It is designed to bring together people seeking employment as a Personal Assistant (PA) and Employers (PAE) looking for potential Personal Assistants. Although this is a new venture, early indications are showing that the Register is popular with PAs and PAEs alike. The number of trigger forms which Age Concern is submitting to social services under the Adult Protection policies and procedures.

22 South East Brokerage & Advocacy Review February Appendix 2: Portsmouth City Council Learning Exercise Information Transforming Adult Social Care in Portsmouth Support Brokerage Learning Exercise Prospectus 1. Introduction Portsmouth City Council is seeking expressions of interest from voluntary and community organisations for a share in the allocation of funding to deliver support brokerage as part of a learning exercise to facilitate the implementation of self directed support for adults eligible for social care services. A total budget of 100,000 is available to be shared between up to 5 organisations. This funding is short term for 1 year only from 1 September 2009 to 31 August 2010, specifically to test out different models of support brokerage. Selection and engagement with the learning exercise will not necessarily lead to a contract with PCC after the initial first year of funding. Organisations taking part in the learning exercise will, in addition to the key deliverables outlined in section five: Work in partnership with the Council to deliver its vision for self directed support Actively participate in support brokerage network meetings Share their experiences of delivering support brokerage with the Council and other organisations involved in the learning exercise Consult with service users and carers to ensure that models of delivery are sensitive to the needs of different user groups Contribute to the development of the Council s long term commissioning plan for support brokerage Deliver a final report on their experience in providing this service and participate in a final evaluation exercise We welcome expressions of interest reflecting the diversity of the local population taking account of cultural and other preferences within the black and minority ethnic community. 2. The Vision

23 South East Brokerage & Advocacy Review February The Government s Transforming Social Care agenda is bringing about major changes to the traditional and sometimes bureaucratic way that social care services are delivered by putting service users and carers in control. Portsmouth City Council s vision is for a premier waterfront city, so that now and in the future it is a place where people will want to live work and play, are safe and healthy, have high aspirations and fulfil their potential. For social care services this means people in Portsmouth have choice and control over the care and support they need to enable them to live healthy and independent lives. Our self directed support programme is a key component to enable us to achieve this vision. We have an ambitious target that by March 2011, 1735 people who use social care services in Portsmouth will have an individual budget and be empowered and supported to plan and direct the care they need. Support brokerage will play a vital role by replacing the traditional process of purchasing care for individuals on a time and task basis and we believe the independent, voluntary and community sector have significant skills and expertise to help us develop and embrace this new way of working. 3. Principles of Support Brokerage Organisations will be expected to embrace the following principles of support brokerage: A clear value base that promotes self-determination and social inclusion Aim to identify barriers to self-direction and social inclusion for all groups of people and put in place responses which tackle these barriers Demonstrate independence from decision making about funding in the resource allocation process Ensure that the person for whom the support planning and brokerage is provided makes the decision (with assistance if necessary) about how the resources are used Provision of information about the range of support planning and brokerage options is a central part of enabling choices Information is available in the format suited to the person concerned. 4. Support Brokerage Functions Support brokerage can be carried out by a range of people and/or organisations: Individuals and families User-led, community and advocacy organisations Independent, specialist brokers Support providers Care managers

24 South East Brokerage & Advocacy Review February It is important that support brokerage is recognised as a range of functions rather than the creation of a new job role. The Department of Health together with the In Control Individual Budget pilot sites have spent considerable time developing and defining support brokerage. Functions include: Finding out what is available Exploring what is possible Providing information (signposting) Giving technical advice Encouraging and developing informal supports Coordinating supports and resources Assisting the person to manage their obligations and responsibilities in relation to their budget Facilitation to enable things to happen Helping with support planning Helping the person speak up for themselves or where necessary to speak up on their behalf Organisations are advised to consult the following document before submitting an expression of interest: Good Practice in Support Planning and Brokerage (Gateway ref 9878). This document is part of the Personalisation toolkit, which can be seen in full at 5. Key Deliverables Selected organisations will: Be able to demonstrate independence, meaning the absence of accountability or loyalty to the council or support provider agencies. More positively it means that the broker is person centred and community centred, with a perspective that values and respects the person, their networks and their experiences. Have and maintain good working relationships with Adults Social Care, support providers and mainstream community resources. Although the broker must have independence, this must not lead to isolation from the rest of the social care system and mainstream community resources that will be an essential component of people accessing new opportunities for inclusion. Work directly, in close collaboration with Adults Social Care, with adults and their carers individual requirements who are eligible for social care services and are either existing or potential individual budget holders Deliver the range of support brokerage functions outlined in section four with a needs lead and person centered approach Assist adults and their carers to develop and initiate appropriate individual support plans visiting them at home as required

25 South East Brokerage & Advocacy Review February Produce monitoring information and reports as requested by and agreed with the Council 6. Outcomes We expect a number of outcomes from this learning exercise. Predominantly it will provide evidence, good practice and lessons learned to enable the Council to plan support brokerage services for the future. Additionally it will: Build capacity in the voluntary and community sector to take forward the personalisation agenda Increase understanding of self directed support among users of adult social care services Increase the number of people who have choice and control as to how their needs are met through individual budgets Improve service user and carer experience of social care assessment processes 7. Funding Funding will be a combination of an up-front payment for training and general advice, payment for attendance at project meetings and payment for Support Brokerage on a spot purchase basis. 7.1 Up-front payment for training There will be one up-front payment to all participating organisations. This is for one day s training, inclusive of travel costs. Each organisation will receive a total of 100, regardless of how many staff members they send to the training. Attendance at training is mandatory for any staff offering support brokerage as part of the learning exercise. 7.2 Payment for attendance at network meetings Participating organisations will be expected to attend regular support brokerage network meetings (up to six half-days during the year). Each half-day will be paid at 75 (inclusive of travel expenses) per organisation on submission of an invoice (quarterly). This is a fixed payment irrespective of how many staff members attend. 7.3 Payment for support brokerage Payment for support brokerage will be made on a spot-purchase basis based on the numbers of hours delivered at a rate of 15 per hour. Payment will be on submission of invoice (quarterly). The rate of 15 per hour includes staff time and