Winterbourne View Joint Improvement Programme. An overview of the Third Party Model for Personal Budgets

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1 Winterbourne View Joint Improvement Programme An overview of the Third Party Model for Personal Budgets People with learning disabilities and their families can really benefit from a personalised approach and they should not be excluded (from personal budgets) simply because they have a learning disability - Dominic Slowie, National Clinical Director for Learning Disabilities Personal Budgets have the power to transform lives especially for people with learning disabilities, autistic spectrum disorder and/or behaviour that challenges. However, personal budgets and direct payments are not offered on a whole scale due to a mistaken belief that many people with learning disabilities lack the skills to manage their own support. With the right support, people with learning disabilities can benefit just as much (if not more) from the choice, control and stability of support afforded by personal budgets and direct payments. Think Local Act Personals report "Personal Health Budgets: including people with learning disabilities" shows that when people and their families get the chance to write their own support plan and have control over the money available for their support, it can lead to better support for individuals who may otherwise end up in high cost, poor quality residential services. Thus it recommended that personal budgets should be considered for all people identified in relation to the Winterbourne View programme and that self-directed support could lead to better outcomes for people with learning disabilities. However, if people with learning disabilities are to benefit from personal budgets, appropriate support structures need to be in place to help with recruiting, employing, retaining and developing personal assistants whilst assuring the personal budget is sustainably managed. That s where a Third Party Model can help. What is the Third Party Model for personal budgets and direct payments? The Third Party Model supports young people, adults and older people with learning disabilities and/or Autism to have full access to personal budgets and the choice and flexibility they afford, namely, access to the benefits of having their own dedicated personal assistant team to support them in the community. Organisations offering a third party service will support individuals and families to reap the benefits of personal budgets and self-directed support whilst shielding them from the often daunting responsibilities that can act as a barrier for many.

2 The Local Government Association and NHS England produced the Core Principles Commissioning Tool Ensuring Quality Services in The tool recommended to commissioners that: Individuals and their families are made aware that they can have a personal budget or personal health budget Children, young people, adults and older people with learning disabilities and/or Autism and their family/carers should be involved in the recruitment process, especially interviews Family and carers are involved in the delivery and review of training sessions The commissioning cycle be worked through establishing best practice, including personal budgets and personal health budgets An organisation providing the Third Party Model can help achieve the above by: Opening up personal budgets and personal health budgets to young people, adults and older people with learning disabilities and/or Autism Helping individuals and families to build personal assistant teams around individuals, fully involving the individual (and family where appropriate) in the recruitment, interviewing, selection and training of the personal assistant team Assuming the responsibility for funding management, insurance, employment of the personal assistant team, training and personal assistant supervision, appraisal and support Working closely with the NHS, Local Authority and the third sector to build a holistic and multi-disciplinary approach to the persons care and support Ensuring the individual is achieving their goals and outcomes based on a proactive support planning process Ensuring long term stability of the support not afforded if parents are employers of personal assistant teams, preventing the yo-yo effect of moving in and out of Assessment and Treatment Units What does the Third Party Model mean for individuals and their families? Under the Third Party Model, individuals and their families can: Choose their own personal assistant team, be it either family members or someone from their local community. If necessary personal assistants can be found via advertising and interview, which the individual and their family will be fully involved with Be relieved of the employer responsibilities the third party will employ their chosen personal assistants on their behalf Have their Personal assistants trained to CQC standards. The individual/family is involved at every step of the training process and training takes place in the home where possible Count on a dedicated independent living nurse to carry out supervisions and update training when required Have a dedicated independent living advisor who will support the individual, family and the personal assistants on a daily basis Have the safety net of a 24 hour, 365 day a year out of hours telephone support service Transition back into a community setting closer to their family What does the Third Party Model mean for commissioners? There is risk involved with people having their own personal assistant team in the community. However, the risk, if properly managed, should not act as a barrier to individuals and families experiencing the benefits of personal budgets and self-directed support. Under a Third Party Model, commissioners have the peace of mind that an experienced and specialist organisation is on hand to ensure everything runs smoothly and protect individuals and families from any potential pitfalls.

3 An organisation working to the Third Party Model can: Set up a separate managed bank account to receive the personal budget, which can receive funding from both social and health care Provide quarterly financial returns and bank account balances on request for any external audit purposes Do all necessary risk assessments to ensure the individual is kept safe and contingencies are in place Provide supervisions of personal assistants to help ensure a stable and happy support team Provide monitoring of the minimum number of personal assistants required in each support package to ensure individuals are keep safe in the event of sickness and holidays Provide monitoring of training competency of personal assistants, including identification of the need to update training Provide peace of mind that the support is overseen by a CQC registered organisation Ensure the package of support is fully insured with employers liability, public/products liability and professional liability First Hand Experiences of the Third Party Model Jason lived in a long stay in-patient unit for 22 years. When he first moved out, some of the staff transferred to a support agency to provide his support. This did not work very well: the system was institutional and inflexible. Jason s sister asked about a personal health budget, as she had heard about the impact a personal health budget had had on a patient in the national pilot. Over the next few months things changed considerably for Jason. His sister became his appointee. With help from an independent support agency she was able to recruit a whole staff team and give the team leader more autonomy in developing a care plan that allowed both flexibility and creativity. Jason is now fully involved in his own support planning. He has moved from his original rented home with all its restrictions to a self-contained bungalow on a farm where he is surrounded by animals (a similar environment to that in which he grew up). His sister has purchased a car on his behalf and the staff can take him out regularly. Since moving to his new home there have been no incidents of self-harm, and there has been a significant reduction in the frequency and duration of Jason s seizures. His sister and staff believe this is down to a more flexible structure and enabling Jason to use up his surplus energy by going for walks. Jason s challenging behaviour has ceased and there is no need for 2:1 or 3:1 staffing. He is now part of the local community and is a frequent visitor to the local pub and social events in the village, supported by one of his team of local workers. Jason continues to have his problems, but his sister reports that his life now has meaning and not just containment and survival. *Sourced from Think Local Act Personal. Personal Health Budgets: Including people with learning disabilities You can also hear Stuarts story at Or hear Frances story at

4 The Third Party Model offers a cost effective and long term solution Local Authorities and Clinical Commissioning Groups can experience a more cost effective approach to support for people with learning disabilities and/or Autism under a Third Party Model, yet with more positive outcomes. The personalised and stable approach to support in the community can lead to reduced costs over time as support settles. Care and support for the majority (86.0% or 2,795 people) of service users who remain in Assessment and Treatment Units costs between an estimated 1,500 and 4,499 per week, with the highest proportion (37.9% or 1,231 people) being in the 2,500-3,499 range. For 11.4% (369 people), care and support provision was indicated to cost over 4,500 per week per person. In the above example, Jason s care and support package over time reduced from 3:1 support to 2:1 support and finally settled at 1:1 support. As an indication, taking an average per hour cost for a personal assistant as 14, the package of support reduced from 4,879 a week at 3:1 support (based on 315 day time hours, waking nights and sleep ins), to 3,340 a week at 2:1 support (based on 168 day time hours and sleep ins) to 1,012 a week (based on live-in). If given time, the Third Party Model can represent greater outcomes coupled with greater efficiencies. HomeCareDirect An Example of a Third Party Service Provider HomeCareDirect are a leading national provider of third party services to people who require support to live independently in the community. This includes older people, children and young people, people with learning disabilities, complex health needs, people with mental health issues and people with physical disabilities and/or sensory impairments. For over 10 years HomeCareDirect have been helping people with learning disabilities and/or Autism to knock down the barriers that exist for personal budgets and self-directed support. HomeCareDirect have a national reach facilitated by a network of independent living nurses throughout England who help individuals and families to direct their own support under the Third Party Model. Areas exist where HomeCareDirect s third party approach has been more widely adopted both in health and social care. These areas include Norfolk, East Sussex, Essex, Nottinghamshire, Derbyshire, North Yorkshire, West Yorkshire and County Durham.

5 The process for transitioning an individual from an Assessment and Treatment Unit back into the community Individual/Family/Commissioner contacts the Third Party Service Provider Indicative funding agreed with Local Authority/Clinical Commissioning Group Mulit-Disciplinary support planning with the Individual and Family - including housing arrangements Final personal budget agreed Advertise, interview and recruit the personal assistant team in partnership with the individual and their family Third party employ and train the personal assistants, insure the package and set up a bank account to manage the personal budget Personal assistant team spend time with the individual in the ATU to create familiarity prior to transition into the community Individual transitions into the community to a personalised support package

6 Conclusion The benefits of personal budgets and personal health budgets for people with learning disabilities have been well documented. It has been recommended that the industry takes a whole systems life approach where the individual is at the centre of planning and commissioning, and Jane Cummings, Chief Nursing Officer for England stated that It is vital that commissioners provide person-centred care. The Third Party Model facilitates this. It also provides a long term, cost effective solution for commissioners, which can lead to individuals transitioning back into their community in closer proximity to their families. Most importantly, this model can be seen as one of the jigsaw pieces for getting people the right support, at the right time, in the right place. For further information on the Third Party Model for personal budgets please enquiries@homecaredirect.co.uk