Commissioning Support Planning and Brokerage

Transcription

1 Practical Approaches to Support Planning and Brokerage London Joint Improvement Programme: Guidance series Commissioning Support Planning and Brokerage Date published: February 2011 Status: Version reference: Final 1.0 1

2 Executive Summary This commissioning guide aims to facilitate a clearer understanding and overview of support planning and brokerage. Embedding an ethos of independence with support across the whole operating framework is critical to developing personalised services and must underpin a Local Authority s approach to support planning and brokerage to enable people to exercise choice and control. The guide will support commissioners to develop a commissioning plan that includes developing and remodelling services to deliver a sustainable approach to support planning and brokerage. It is hoped that commissioners will proactively review the delivery of support planning and brokerage functions across the whole of the local operating framework, rather than see support planning and brokerage as an isolated activity that is added on to existing contract and operational arrangements. Support planning and brokerage are not wholly new functions for Local Authorities to arrange, so in itself it should be considered cost neutral. The innovation and culture change resulting from effective planning and brokerage however should deliver better outcomes and value for money. This guide outlines the range of models for support planning and brokerage that will facilitate a focus on individuals and that can be integrated into the local operating framework. This guide should be reviewed in partnership with individuals, families, carers and organisations representing their interests to ensure they have opportunities to influence commissioning decision and processes. This will be key to identifying the priority attributes for support planning and brokerage services and the preferred local delivery models. We also hope this will be a useful guide for all provider organisations, particularly those from within the third sector, to design and plan services that are diverse and flexible and fit the needs of individuals and carers. Commissioners, front line staff and providers may find it useful to use the guide to review current provision, identify gaps and where capacity needs to be built in the system to provide a range of support planning and brokerage options. The guide references a number of resources that local authorities may find useful to assist with local developments. A checklist is also included for commissioners to use when determine what models of support planning and brokerage they will commission, the potential pros and cons of these models and particular interface issue that should be addressed locally. 2

3 Background In June 2010 the London Transformation Leads Network met to explore approaches to Support Planning and Brokerage. A number of key issues and areas for further development were identified at this meeting. In response to these the JIP Personalisation Board commissioned a set of four Special Interest Groups (SIGs) to deliver practical guidance, products and examples of best practice in the areas of: 1. Knowledge, skills and behaviours for support planners and brokers involved in supporting people to plan, manage and purchase the care they need 2. Delivery models and commissioning strategies identifying the range of models available to support people and providing guidance on commissioning an appropriate range of services locally 3. Quality, dignity and risk management - Approaches to help people and those supporting them in planning, managing and purchasing care in selecting high quality and safe services. A key component to this will be enabling people to manage risk. 4. Streamlined support planning and brokerage processes - Developing guidance on a streamlined pathway for support planning and brokerage to minimise duplication within assessment and review processes and provide a person centred customer journey. This is the report and output from the Commissioning Support Planning and Brokerage Special Interest Group. In order to provide a consistent approach for the SIGs we developed a set of clear parameters for the work of the groups: For the purposes of the SIGs support planning was assumed to start after the RAS is applied and an indicative budget allocated. The emphasis should be on creativity and supporting people to have genuine choice and control Where possible there should be a variety of options available including user lead support (LA should provide choice for individuals in how they have SP & Brokerage needs met) Where possible people should be encouraged to develop their own solutions using accessible advice and information, supporting choice and control (the ability to signpost individuals and the use of high quality information to enable individuals to self manage) The new customer pathway will support/enable people to assist themselves resulting in fewer people requiring formalised support with their ongoing care needs Options must minimise professional input not creating a new tier of professional, recognising where there is a statutory need for social care professional input eg. assessment and safeguarding. Keep it simple, designing around the service user and not making it complicated or bureaucratic 3

4 Principles of high quality support planning and brokerage Personalisation sees everybody as being resourceful and having something to offer society. People are treated as equal citizens with rights and responsibilities. It puts people and their aspirations at the heart of any support someone is seeking. Personalisation and self directed support are essentially about people having voice, choice and control in their lives. Below are six key principles that are fundamental to all good support planning and brokerage practice and the products from the SIGs aims to ensure that these are delivered. 1. Right to Independent Living - I can get the support I need to be an independent citizen, my need for that help is recognised and the right kind of support is available to me. 2. Right to a Personal Budget - I know how much money I can use for my support and I can decide how the money that pays for that help is used. 3. Right to Self-Determination - I have the authority, support or representation to make my own decisions and that reflects my needs and preferences. 4. Right to Accessible Information and Advice - I can understand the rules and systems; help is available to me and I am able to use it. 5. Right to Flexible Funding - I can use my money flexibly and creatively. I am free to spend funds in a way that makes sense to me, without unnecessary bureaucracy. 6. Accountability Principle - I should tell people how I used my money and give feedback on the quality of services. Special Interest Group Lead and Membership The output from each special interest group was co-produced with input from London authorities and others with experience of the topic within a personalised system. The following people provided the steer and content for the development of this commissioning guide: Hugh Cole, London Borough Westminster (Chair) Sarah Ford, London Borough Tower Hamlets Caroline Tack, London Borough Richmond Helen Shewa, London Borough Hackney Linda Martin, London Borough Brent Rebecca Jarvis, London Borough Bromley 4

5 Claire Drake, London Borough Camden Rahat Ahmed-Man, London Borough Merton Matt White, London Borough Enfield Avril Mayhew, London Borough Kingston Julie McCauley, London Borough Merton Natasha Cooper, DH (London) Status and Quality Assurance This is 1 of 4 papers produced by the Special Interest Groups detailed above, offering tangible, practical and relevant guidance for London authorities. These papers are NOT intended to be prescriptive and should not be interpreted as policy. Each paper details the key issues that the members of the SIG believe are important and offers practical solutions and a way forward. The Putting People First national team commissioning lead provided some valuable guidance to the Commissioning SIG, particularly in relation to provision of funding to individuals for support planning and brokerage. The guidance was also reviewed and cross referenced at various stages by the SIG coordination group, which drew membership from In Control and JIP programme leads. The guidance offered is intended to work now. Therefore, each paper is framed to have a shelf life of 6-12 months. 5

6 1.0 Introduction This commissioning guide aims to facilitate a clearer understanding and overview of support planning and brokerage, and models of delivery. Embedding an ethos of independence with support across the whole operating framework is critical to developing personalised services and must underpin a Local Authority s approach to support planning and brokerage to enable people to exercise choice and control. The delivery of support planning and brokerage needs to be carefully constructed. For many individuals this is the opportunity to articulate what is important to them, and how they want to be supported to live the life they want. This way of working will require nurturing, regardless of how it is delivered, with strong leadership to ensure there is a change in culture and approach across the system. The guide will support commissioners to develop a commissioning plan that includes developing and remodelling services to deliver a sustainable approach to support planning and brokerage. It is hoped that commissioners will proactively review the delivery of support planning and brokerage functions across the whole of the local operating framework, rather than see support planning and brokerage as an isolated activity that is added on to existing contract and operational arrangements. Support planning and brokerage are not wholly new functions for Local Authorities so in itself it should be considered cost neutral, particularly if Local Authorities look to provide a range of models that align with other areas of provision. The innovation and culture change resulting from effective planning and brokerage however should deliver better outcomes and value for money. 2.0 Support Planning and Brokerage Principles A key principle of personalisation is that people can choose who they want to assist them in developing and delivery of their support plan. Following on from their assessment and indicative resource allocation individuals, families and carers should be provided with information about the range of options available for developing their support plan and then implementing it. Support planning and brokerage roles can be performed directly by the individual or can include assistance from other sources. It is important that social care workers and those involved in supporting self directed assessments provide information on: - the support planning and brokerage process including the ratification of plans, risk assessment, contingency planning and documentation requirements 6

7 - the tools and services available locally to either enable a person to carry out these tasks themselves or how they can get help Workers should take care to ensure individuals, families and carers are aware of all options available and that they do not unduly encourage a care management approach to support planning. Support Planning and Brokerage are not new or additional functions, rather it is a change in how these functions are approached and delivered that is new. These functions have traditionally been carried out within social care as part of a Local Authority fulfilling its statutory responsibilities. Local Authorities will need to satisfy themselves that within their approach to Personalisation they are discharging their duties to produce care plans and arrange services for individuals who are eligible for community care services. In developing the options for support planning and brokerage it is important to remember that there is no right or single model that will suit the requirements of every person. Commissioners have a key role in ensuring that individuals have a mixed economy of options available to them in relation to support planning and brokerage. To develop the options commissioners should concentrate on the functions required, that are outlined below, rather than defining specific roles or professional titles. It is important that support planning and brokerage models build on and complement local good practise, including existing care management and back office functions, and do not add an unnecessary layer of complexity and duplication. Importantly local systems should support individuals to shape their own life and this should include people having the confidence and skills to develop their own support plans and make them happen and help others to do the same. People do not necessarily require the levels of assistance that have traditionally be part of social care systems. Use of existing personal capabilities and resources should be the default option, where local systems encourage people to do more for themselves. 3.0 Defining Support Planning and Brokerage In order to design an effective support planning and brokerage service that adds value to the health and social care sector, the purpose of the service needs to be clear. 7

8 Department of Health guidance on support brokerage 1 identifies a range of activities that make up support brokerage which range from completing assessments to assisting with quality assurance processes. This however is a very broad definition crossing into all areas of the operating model and may make it difficult for Local Authorities to commission the functions particularly needed in their locality. For the purpose of this guide, the Special Interest Group agreed that the term support brokerage would cover those activities that happen after assessment and the resource allocation process. It is evident that across London there are a range of services that provide support brokerage but there is a different interpretation of what this means locally. Current services in one local authority may for example, involve providing external assistance with support planning but all brokerage functions are performed in-house or visa versa. Whilst support planning and brokerage can be a fluid process and the functions could occur concurrently rather than in a linear way, it was felt important to make it clear what was being commissioned. The list of functions below illustrate there are potential overlaps activities performed at the different stages. A clear definition of functions will assist commissioners to consider how support planning and brokerage fits within their operating model and to map where these functions are currently being performed by in-house or external services. This is in keeping with the work done by Aged Concern Bromley 2 in developing a model service specification and will help commissioners build a sustainable financial model for support brokerage. Defining Support Planning The process by which a person develops a plan of the support they need to live life the way they want, and which how they intend to meet individual goals within available resources. Resources include those that the individual have available to them such as social and community networks, private finances and their indicative personal budget from the Local Authority. Defining Support Brokerage Support Brokerage is the act of arranging and coordinating the support needed to meet the outcomes identified in a support plan. This includes 1 Good Practice in Support Planning and Brokerage (published on Putting People First, DH, 2009) 2 Support Brokerage Specification Draft (published on Putting People First website, DH, 2009) 8

9 accessing information and advice to develop cost, negotiate and mediate plans as required by individuals. 3 Support Planning functions Planning of support can include the following actions: Understand needs and desired outcomes as expressed by the individual Support and advocacy to express needs and preferences Develop understanding of all existing support systems both formal and informal Develop understanding of all existing financial resources and other potential resources Preparing and recording (in writing, audio, picture format etc) of needs, priorities and ways that support needs will be addressed Preparing indicative costing Prioritise use of budget Innovative and flexible use of available resources, including accessing additional or non-traditional support and financial resources Consider risk and identify how risks will be managed Undertake risk assessments and contingency planning Support Brokerage functions Brokerage of support can include the following actions: Support the development and sustainability of a personal support network Identify and apply for funding from all government and non-government sources Identify and support access to community resources Assist with funding negotiation with commissioners Direct liaison and negotiation with service providers Arrange and implement plans as directed by the individual, family and personal support network. This includes preparing indicative costings Monitor and evaluate provider services in conjunction with existing monitoring and quality assurance frameworks. Mediate and resolve problems (as directed by the individual) 3 Adapted from Service brokers parameters of best practice (Salisbury B. and Webb P, 2003) 9

10 Provision of Direct Payment support such as payroll, assistance to recruit, HR advice Hold personal budget and manage financial transactions, including appropriate accounting and audit requirements Interface with other stages of the operating model For support planning and brokerage to be efficient and effective for the individual there needs to be clear linkages and an integrated approach with those parts of the system offering information, advice and advocacy and with the assessment process. This needs to be reflected in the culture and ethos of the organisation, where all people and processes support and actively enable individual participation and control. Information, advice and advocacy Information, advice and advocacy functions can overlap significantly with support planning and brokerage functions and therefore may provide an opportunity for re-commissioning elements of these services to deliver specific functions as part of the operating model. These include: Explaining social care roles responsibilities and processes Information on wider local authority functions Information on local and regional services and support organisations Providing information on self directed support Information on funding sources Information on Direct Payments Welfare Rights information Information on social care appeals and complaints processes Support to express needs and wishes Assessment and review The assessment process has a critical relationship with support planning and brokerage, not only because it drives the resource allocation system but because it establishes the relationship the individual, family and carers has with the local authority. The review stage of the process is also a key activity as this will be the opportunity for the individual to identify whether or not they are achieving the outcomes as set out in their support plan. As outlined in the principles of support planning, individual s, families and carers must be made aware of what tools and services are available locally to facilitate support planning and brokerage and this information should form part of assessment and review stages. Social Care workers who provide support 10

11 planning and brokerage functions will need support to develop a more person centred way of working that goes beyond traditional care planning and use of local authority commissioned services. This requires significant leadership, system change and a risk enabling culture to shift the balance of power to individuals. Verification of Support Plan Local Authorities will need to sign off support plans and agree final personal budgets. It is important that this process of verification can interface with all of the models of support planning and brokerage, to make it straightforward, eliminate duplication and reduce any unnecessary delay in organising the support an individual requires. A risk enabling approach will be critical to ensuing the Local Authority does not unduly limit innovative and truly personalised use of personal budgets. Direct Payment support services Direct payment support services often provide a range of support functions that fall within brokerage. Local authorities in London are fairly evenly divided in regards to whether the service is provided internally or externalised to a third sector partner. When commissioning support planning and brokerage, it will be necessary to ensure there is clarity of remit and functions in regards to providing direct payment support. If services are commissioned separately it is important to ensure the various services complement each other and that all are working towards empowering individuals to gain the skills to be self sufficient in managing their budgets rather than relying on a model of ongoing support. Provision of support The process for planning and managing personal budgets will mean nothing if it is not aligned with work to personalise the care and support people receive. Personalising support should be the focus of service delivery, regardless of whether the support is residential, non-residential, in-house or external. This will require providers of services to review the way they engage and work with individuals. Providers must build a direct relationship with the individual and review their service offer to fit it around the individual needs and priorities of their customer. Getting Personal 4 and Progress for Providers 5 provide a mean for self assessment of progress in delivering personalised services and should be a useful tool to support commissioners and providers to work together to improve the service offer. Shaping the market for personalisation: 4 Getting Personal measuring providers progress (SCIE, 2010) 5 Progress for Providers (Helen Sanderson Associates, 2010) 11

12 diagnostic and action planning tool 6 is another tool to support councils and other commissioning agencies to understand their progress ad plan next steps in commissioning personalised services and developing the local market for choice and control. 4.0 Models of support planning and brokerage There are a number of publications that detail the range of models for support planning and brokerage 7. This section aims to give an overview of these models and clarify what the commissioning implications are for each. All models should focus on enabling individuals to gain the skills and confidence to be involved in all aspects of support planning and brokerage. Even those services providing high levels of assistance should work with individuals to transfer knowledge and aim to ensure there is a throughput of individuals and carers rather than a model of life long support. This is in keeping with the principles of self-directed support and also essential for sustainability. Self and family Enabling people to actively develop their support plans is key to enabling them to direct their own support. People are more likely to consider the range of formal and informal resources and support available to them and prioritise the use of their personal budget based on what is most important to them. Some individuals and carers are already experienced in planning and negotiating with care managers and providers, particularly on a day to day service delivery basis. Commissioning implications Access to information and self-help tools are the key enabler for this model to work. These also provide the foundation to support all other delivery models. - Commissioners should ensure information is available on all aspects of support planning and brokerage, and wider social care systems. This must include what is required in a support plan and what records are required for personal budget spend. - There should be easy access to tools to assist individuals to undertake the range of functions outlined earlier. This could be templates such as those 6 Shaping the market for personalisation: diagnostic and action planning tool (available on Think Local, Act Personal pages on SCIE website from April 2011) 7 In-control, PPF etc 12

13 used in person centred planning and how to guides that reflect local arrangements. - Commissioners need to ensure local information and advice is readily accessible and up to date. Information needs to support the key decision factors of availability, affordability, suitability and quality and safety. 8 Information needs to cover a broad range of needs including traditional and innovative local services, community organisations etc. - Web based resources and interactive tools are an important part of the infrastructure for self directed support. Shop4support work with Harrow and Quickheart in Enfield are examples of systems that will support individuals to plan their own support and engage with the provider market. Commissioners will need to work with the operational teams and back office support services to ensure internal processes enable and facilitate individuals to undertake support planning and brokerage. Community based resources These are the vast range of community based services such as faith groups, libraries and the voluntary sector organisations that people already access for a range of reasons. There is an opportunity to make better, more focused use of these community services that are already set up and in some cases funded by the local authority. Commissioning implications - People may need support following assessment to identify community resources they already access/have a relationship with eg faith organisations - Community organisations will need access to training, information and capacity building - Can be more outward focused ie not tied into traditional social care services and therefore recognise and utilise social networks and wider community involvement opportunities. - Access to tools and information as outlined above is required to capitalise on these resources. Peer led Peer led support planning and brokerage is support delivered in a planned way by individuals who have had experience of developing their own support 8 Transforming adult social care: access to information, advice and advocacy summary (IDeA, 2009) 13

14 plans and arranging their support. Individuals volunteers their time to assist individuals. It requires work with volunteering organisations to develop the service, to ensure appropriate supports are in place for the individual. The actual support can be delivered to individuals who have been matched together locally or in a group setting to facilitate shared learning and problem solving. Commissioning Implications - Requires commissioning and facilitation to build capacity. Commissioners will need to invest into the set up and coordination of the service to ensure it is sustainable. - Can be done in relatively informal settings in regards to actual delivery of the support such as through existing networks and day opportunity. - Group discussions and planning may be an effective way to introduce the concept of self directed support to individuals who are used to receiving a very traditional service. Commissioners will need to consider how the group is facilitated. - Volunteers will require access to training and support such as through peer forums. - Access to information and tools as outlined above is key. - There may be opportunities to align the model with employment and training opportunities to enable volunteer participants to develop their skills for future employment opportunities. Use of care service providers (ISF) This model involves a care service provider holding and managing the Personal Budget on behalf of an individual. The service provider is contracted to provide services that are tailored to the needs and requirements of that individual. This arrangement can be directly with the individual and provider or could be via a local authority contracted care services provider. The provider would work with the individual to agree the support plan, including what their priorities are and how they would like their available funds to be used. The personal budget would effectively be turned into an Individual Service Fund. It would also enable the individual to agree cover arrangement when for example their primary support carer is off sick or on leave. Implication for commissioners - Commissioners will need to determine whether the contract with providers specifies responsibility for money management 14

15 - Contract will need to enable subcontracting where the individual has requested a service that the provider can not provide. - The provider would also usually agree a contingency plan with the individual and agree how any underspend would be managed. - Providers need to have good knowledge of who else is providing in their area and foster collaborative working arrangements - Providers will increasingly need to market their services to individuals which will increase the availability of information on service range, quality etc - Systems may need to be established to enable people to freely comment on service quality and also to change providers if they are unhappy with either the service or the management of their budget. -Need to ensure providers are motivated to identify other ways of people spending their personal budget rather than just offering traditional services and delivery options. - Commissioners will need to facilitate and support market development and quality improvement, as initially these may not be driven by individual commissioning decisions. Commissioned Support Planning and Brokerage services Assistance with support planning and brokerage is provided by a service specifically commissioned to provide this type of assistance and is not linked to the local authority. This should allow individuals, families and carers the opportunity to be provided with support that is independent of the local authority and the allocation of resources. Implication for commissioners - Need to clearly define what functions the service will carry out and what the expected outcomes are. - Need to establish whether individuals and carers will be given a choice of providers - May want to contract with a range of providers, possibly on a framework agreement. - Models for contracting may include a simple pricing system or one that attempts to reflect the intensity of support required at an individual level - User led organisations are a key provider for this model, as members of the organisation have experience and knowledge of local support services and systems to draw from. ULO s also support: 15

16 - Improve networking and collaboration between voluntary sector, which can provide opportunity to share management costs and other expenses between providers. - facilitate integrated provision of services across client groups and support collaboration between service providers - The offer independent advice and support, often based on direct experience of receiving services - Commissioners will need to consider how it fits in with direct payment support services as there is potential overlap of functions. - Commissioners will need to ensure the specification encourages and incentivises different approaches to providing support rather than be based on a care management approach. This should include encouraging providers to support people to gain the necessary skills to become their own support planners and brokers. - Some Boroughs who have commissioned support planning and brokerage services have reported that the cost of this service model is equal to or greater than the cost of more traditional care management services. An outcome based rather than output based (eg hour based) approach to contracting should be used to provide a focus on quality and ensure costs are based what has been achieved. - Need to be clear of the role of the commissioned worker if they disagree with the allocation of resources, and the agreed ways of dealing with this. In-house services This service model is delivered and managed in-house by the Local Authority. This could involve current assessment and care management staff undertaking all support planning and brokerage functions or a local authority may create specifically defined roles, or a mix of the two. This model provides a continuity of service across the care pathway, which may be particularly important when supporting chaotic individuals and families or those with very complex requirements. - Where assessment and care management staff provide the service it may be worth considering whether they work with people that are not necessarily on their ongoing case load to provide a level of independence from assessment and resource allocation. - This model may be more effective in supporting integrated commissioning and service delivery. It could be part of a multidisciplinary team approach (which can include health and housing support) to provide expertise and a holistic plan. 16

17 - This model may fit well where individuals have significant fluctuations in their medical condition or personal circumstances and changes in resource allocation and support plans is often required. - there may be more efficiencies in this model as it reduces the number of hand offs between teams/organisations but it is important to ensure there is a shift in culture and the approach to working for individuals. - Care needs to be taken to ensure in-house brokers are not restricted to procuring services from standard local authority contracts or in-house services only ie they are able to broker with a range of providers. If existing contractual or operational arrangements limit this then it is important individuals have access to other models of support planning and brokerage. - Commissioners will need to ensure contracting arrangements such as framework agreements provide for a wide range of service offers, not just traditional domiciliary care. - Commissioners will need to facilitate and support market development and quality as these will not necessarily be driven by individual commissioning decisions. 5.0 One off support or ongoing service Contracts and operational arrangements should provide incentives to shift the delivery of support to a model that encourages independence and skill gain. A reduced reliance on formal support for planning and brokerage is in keeping with the objectives of the Personalisation agenda where there is a focus on building social capital and promoting wellbeing, choice and control through personal budgets and self-directed support. Current care management processes within a Local Authorities provide for individuals where annual contact and review is adequate to ensure their needs are being met as well as for individuals who require intensive ongoing support. Traditional Direct Payment support services also provide for a range of support needs ranging from one off support to intensive support to facilitate ongoing service delivery. It is important that support planning and brokerage services do not become a default care management service, providing a dependency on these services to negotiation changes with the local authority or care and support providers. Commissioners should consider using the full range of models outlined in the previous chapter to ensure individuals access the level and intensity of support they actually require. 17

18 6.0 Funding of support planning and brokerage As Local Authorities face increasing financial constraints there is a need for commissioners to develop sustainable models for support planning and brokerage. There is a range of good examples across London where boroughs have used the Social Care Reform grant to specifically build local capacity in one or two delivery models. However all boroughs will need to consider what their operating model will look like once the grant ends in March Allocation of funding A key consideration for commissioners and operational services is whether brokerage and support planning can be paid for at an individual level. The points below aim to outline the key issues that a local authority will need to regard. - Under current legislation a local authority can not charge individuals, families and carers for assessment and care management functions. It would be difficult therefore for a local authority to include an allowance for support planning and brokerage functions within the RAS as this often supports the calculation of service charges or contributions. - If a fixed allowance is made, it is likely to mean over supporting some people and under supporting others. It would be difficult to ensure those people with need for high levels of assistance have access to adequate resources. It also creates an inequality where people create their own support plans and broker their own support packages. - An allowance based on the percentage of the allocated resource is unlikely to effectively reflect an individual s requirements for assistance. A high resource allocation does not necessarily mean a complex support planning and brokerage requirement. Also it is likely to disadvantage older people who generally receive a lower resource allocation. - If the allowance is based on an assessment of need for assistance then it risks making an already complicated process even more complex. - Providers can charge self funders and those not eligible for state funding if they would like assistance with any of the support planning and brokerage activities. - Allocation of funding directly to individuals to buy brokerage is likely to be unfair as it is hard to allocate the right amount of money, given the different amounts of support people will need. This is particularly true for the minority of individuals who require intensive ongoing support to sustain involvement with services 18

19 - A grant funding and contracting approach enables a local authority to develop a range of models of support planning and brokerage. This approach will enable commissioners to facilitate: A shift in culture and systems to encourage self support as default option Provision of a universal offer of some functions, particularly important for self funders and those not eligible for state funded service Access to specific support for those that need it Sustainable funding To create a sustainable approach to support planning and brokerage commissioners will need to identify how resources can be shifted within funding levels to provide assistance across the spectrum. Care Management A recent report published by The Centre for Welfare Reform 9 outlines an interesting approach in Yorkshire and Humber to quantify care management functions and a model for reinvestment. The model identifies that whilst there will remain a core care management and crisis management function such as information giving, assessment and review, there is the potential to identify a percentage of care management time that could be invested in support planning and brokerage functions. This amounted to 32% in the participating boroughs although this needs local analysis and understanding in the context of how personalisation has been adopted across the organisation. Other council services Resources that are currently tied up in financial assessment officers, income maximisation officers could be refocused to provide a wider range of support planning and brokerage functions Resource centres and day services staff could provide assistance to individuals and carers to develop support plans. This could be particularly effective if offered at the annual review stage for individuals receiving traditional care packages. Housing related support services provide an opportunity to provide one to one support and regular contact with individuals and families. The way these services work with individuals could facilitate self reliance and there may be opportunities to utilise the time they spend with individuals to engage with support planning and brokerage. 9 Architecture for Personalisation (The Centre for Welfare Reform, 2010) 19

20 Voluntary sector services The voluntary sector provides specific services that are funded either by social care or wider corporate departments. Boroughs will be developing or reviewing their Information, Advice and Advocacy (IA&A) strategies, of which the voluntary sector is a key provider for social care. Commissioning a menu of support options As Boroughs review the level of funding available and prioritise what services to commission, there is an opportunity to build in outcomes that include a range of support planning and brokerage functions. Identification of efficiencies and opportunities for re-provisions will require close working between commissioners, operational teams and providers. It is likely that care management staffing budgets will be expected to provide the majority of resources for support planning and brokerage. It is recommended that boroughs work through a process to establish what resources, either as funding or staff, can be allocated to support planning and brokerage functions. The study by the Centre for Welfare Reform mentioned earlier provides a very useful example of how this could be approached. Commissioners will then need to work with individuals, families and carers to develop a strategy and understand the potential local use and therefore level of investment in each model of support planning and brokerage. It is suggested that the most efficient models would involve people planning and organising support themselves or with minimal input from peers and community services such as CAB or faith groups. It may be possible to meet the needs of 40% to 50% of people through these models. 10 These support models are less resource intensive and are unlikely to require ongoing intensive contact. These models would be suitable for individuals who are eligible for support from the local authority and at the same time likely to meet the needs of self-funders and those either that are not FACS eligible or who do not receive statutory funding. They also form the building block for the other models, especially in relation to provision of information and tools to enable individuals to fully engage with the process. The remaining resources should then be invested into more formal forms of support planning and brokerage. This would meet the needs of individuals with more complex, and would include developing Individual Service fund 10 Architecture for Personalisation (The Centre for Welfare Reform, 2010) 20

21 arrangements, commissioning specific support planning and brokerage services and ensuring in-house services are available for those that require it. Further modelling and engagement with individuals, carers and operational teams/provides would be needed to agree the value attributed to each model. An important consideration of efficiencies and making the best use of resources is the need to minimise transfers of responsibilities between services and organisations. These are often purely system driven rather than adding to the quality of service individuals receive. Along with mapping where in the local operating model the various functions are carried out, the flowchart in Figure 1 may assist localities to think through what range of models they will make available. Figure 1 Assessment Non FACS eligible Self Funder State funded Self Self Self Community based resources Community based resources Community based resources Peer led Peer led Peer led Purchase own support Purchase own support Use of care providers (ISF) Commissioned support services In-house service Appendix A also provides a checklist that localities may want to work through to ensure they have considered the key pros and cons of each model and addressed how they will work within current systems. 21

22 CONCLUSION As personalisation is embedded within social care, commissioners have a key role in ensuring individuals, families and carers are supported to be informed consumers of services, which includes involvement in the commissioning and management of the services they receive. Support planning and brokerage is fundamental to providing a shift in the way individuals experience care and support. By planning and procuring a range of support brokerage models commissioners will be facilitating the change in the system that is necessary to enable self directed support to flourish. Commissioners have a key role in developing the care and support market. To do this they need to have a clear understanding of what services different groups of people want to buy with their personal budgets. This will require commissioners and those providing support with planning and brokerage to work together to understand the purchasing behaviour of individuals. Through the commissioning of support planning and brokerage, commissioners have an opportunity to bring together providers and operational teams to build an understanding of personalised service provision. This is a fundamental element of embedding personalisation and choice across the operating model and ensuring the offer to individuals, families and carers meets their needs and aspirations. 22

23 Appendix A - Support planning and brokerage options Commissioner Checklist Options Cost effective provision? Provides Independent advice and support Can access/link with internal systems eg IT? Can manage funds? Make information available to inform commissioning and market development Provides choice to user? Can provide ongoing support brokerage? Ensure Quality? Self/family/carer Peer/community support ISF/ provider SP&B provider ULO In-house (SW/OT/broker) 23

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