Practical Approaches to Support Planning and Brokerage London Joint Improvement Programme: Guidance series Developing a Streamlined Process for Support Planning & Brokerage Date published: February 2011 Status: Final v1.1-1 -
Executive Summary This paper details the outcome of the Streamlined Process for Support Planning and Brokerage Special Interest Group. It is aimed at Assistant Directors, Commissioners and Team Managers as a guide to support development of local streamlined processes to assist in implementation of personal budgets. The guide details the background to this project and outlines the principles of good quality support planning and brokerage that provided the foundation for the special interest group. Following CSED s Business Process Re-engineering (BPR) Methodology, the group developed a generic process, (see page 10). This process enables local authorities to promote individual, family & carer support planning and brokerage as the default approach allowing local authorities to focus on providing support to those that are not able to be self sufficient. By adopting this approach support local authorities are creating a financially sustainable operating model for Adult Social Care. However, to be successful this process relies on good quality advice and guidance in the form of easy to read guidance aimed at the individual, family & carer. The process developed by the group is intended to be generic and more detailed process mapping is required at a local level to implement the process, further guidance on how to do this is signposted in this guide. Please refer to the associated papers on this topic for additional guidance on implementing Support Planning & Brokerage. 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 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. - 2 -
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 Streamlined Process for Support Planning & Brokerage 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 work input eg. assessment and safeguarding. Keep it simple, designing around the service user and not making it complicated or bureaucratic 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 -
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 guidance offered is intended to work now. Therefore, each paper is framed to have a shelf life of 6-12 months. Thanks to the individuals who gave their time to join the Special Interest Group who steered the development of this guide. Also the Local Authorities who shared their work with this group on which this guide is based. Khosi Mabena, LB Hackney Jemima Styrdom, LB Hackney Anastasia Appah, LB Havering Jeremy Croxall, LB Camden Lucy Vaughan, LB Islington Annmarie Turnbull, LB Lewisham Julie McCauley, LB Merton Heather Begg, LB Merton Vinesh Kumar, LB Redbridge 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 National PPF Team and CSED have also contributed to the final drafts their comments, ensuring the content is consistent with national thinking in this area. - 4 -
Report from the Streamlined Process for Support Planning & Brokerage Special Interest Group Approach The approach to developing the Streamlined Support Planning & Brokerage Process for London Boroughs was a modified version of Care Services Efficiency Delivery Programme s (CSED) Business Process Re-engineering (BPR) methodology. This approach has been deployed successfully in numerous local authorities throughout England, including many London boroughs to redesign their customer pathways. At a programme level, the approach is split into three major phases of work: As Is Analysis, To Be Design, and Develop Generic Solution. The graphic below illustrates the main phases of work with detailed activities and outputs identified. The approach utilises a Lean improvement methodology that guides project teams through a series of steps, tools and techniques to enable them to analyse, measure and redesign their operation. The methodology enables team-members from across organisations to work together to achieve a common goal; in this case, representatives from six London-based local authorities worked together to redesign the Support Planning & Brokerage process specific to their local authorities needs. This approach enabled the group to draw from their own boroughs experiences of what is & isn t working to create an optimum process. - 5 -
The methodology is drawn from CSED s standard toolset and is available to all London Boroughs free of charge. The methodology is based on a threephase, seven-step approach: The SIG completed phases 1 to 4 of this project cycle, the remaining phases from 4 to 7 are the steps required to take forward the output from this group and implement locally. A full guidance pack to the methodology to support local implementation can be found on CSED s website. 1 For the purpose of this project the steps were carried out as follows: 1. Set the Strategy: Documents the Programme s objectives, measures of success, identifies and prioritises stakeholders. In this instance the project brief set the objectives for what was to be achieved Develop guidance on a streamlined pathway for support planning & brokerage to minimise duplication within assessment and review processes and provide a person centred customer journey. 2. Document Processes: The core output for this Phase, As Is mapping, is conducted for the areas of activity under review; metrics are collected; issues and opportunities for improvement are identified and documented. As this was a collaborative piece of work the current as is processes were not formally documented however, strengths issues & opportunities from current 1 www.csed..dh.gov.uk Care Management Process, BPR methodology - 6 -
practice across the contributing boroughs were collated to inform the next phase. 3. Prioritise Opportunities: The issues and opportunities for improvement are prioritised according to the objectives of the project; as this was a collaborative project to deliver a generic process priorities were established around common and transferable issues & opportunities. 4. Develop the Solution: A high-level blueprint process design was constructed, incorporating the objectives & approved by the SIG. This output from this phase has been designed for London Boroughs to take forward and develop their own local detailed processes, policies, procedures and job descriptions. Taking the learning from this SIG, London Boroughs will be able to work from Step 4 to complete the rest of the steps to achieve change. 5. Plan Implementation: Once the solution has been agreed by the Senior Management Team, implementation planning begins. This will be influenced by the speed at which roll-out is desired, other programmes underway within the organisation, and the availability of resources. 6. Implement: The new solution is rolled-out. This will progress faster or slower depending on local circumstances. 7. Deliver Benefits: This final step is an ongoing monitoring function, to ensure that the promised programme benefits are being delivered. If not, progress through the cycle again (albeit a lot faster) to address areas of under-performance. - 7 -
Programme Scope: The scope of Support Planning & Brokerage as described in the Background section of this document is demonstrated in the graphic below: Inputs: - Indicative budgets -Reviews - Advice & information query Outputs: -Care & support plans -Services -Equipment - Direct payments - Virtual/managed budget - Individual service fund Suppliers: - Social workers Support Planning & Brokerage Process Customers: -Service users / customers / citizens - Self funders The input to the process will be an indicative budget, a review, or an information & advice query. Typically these inputs will be supplied by social workers or front-line support workers. Support Planning & Brokerage Process for London Boroughs The following process was developed by the SIG and reflects the needs of the representative local authorities, all London Boroughs. The model is presented at a level of detail high enough for individual local authorities to tailor the model to their own unique circumstances; and with enough detail for local authorities to understand the new process flows. Support Planning & Brokerage forms part of a continuous process within Social Care. The processes are linked intrinsically to the Access, Information and Review functions which together form the user journey through the service. The process presented here assumes that service modernisation, specifically the implementation of best-practice models that reflect the values contained within Putting People First, have been or currently are being implemented within local authorities. The newly designed model promotes the following objectives that reflect the values contained within Putting People First: Promotes choice and control - 8 -
Promotes and enables individuals to complete the required steps with minimal Local Authority support if required Enables individuals to choose how guidance through the process is delivered Places the individual at the centre of the process Focuses on outcomes that people want and choose Is planned and proactive Ensures that people, especially those with more complex needs, receive coordinated care packages Enables users to understand and manage risk Identifies opportunities for early intervention Provides support and information to help the person live independently Facilitates joined-up working between different professions - 9 -
Support Planning & Brokerage Model This flowchart outlines the key steps in the process and promotes, individual, family & carer support to complete support planning. Notes to support this chart are detailed on the following page. - 10 -
Flow of activity: The input to the process is a completed Supported-Assessment Questionnaire (SAQ), an assessment from the Homecare Re-ablement Service, or an initial contact or contact assessment. 1. Indicative budget is calculated a. Working with family and carers takes place through the whole process, further guidance for professional when working with carers is included at Appendix 1 b. The financial assessment process may begin at this stage or could be instigated at SAQ stage in some instances 2. Signposting is offered to all users of the service, whether they qualify for local authority-funded services or not. Signposting will vary by case, and will occur at various points throughout the process. a. Homecare Re-ablement is likely to be completed prior to an individual commencing support as a period of successful reablement will impact on an individuals ongoing care needs. b. However, depending on individual circumstances support to develop further independent living skills may be offered in conjunction with the rollout of the Support Plan; in this case, it is likely that the Support Plan will be revised once the period of additional support is complete as the user s needs will likely have changed. 3. Once users have a Personal Budget allocated, they are sent information describing the Support Planning & Brokerage process, and the planning support options, this may be supported by a conversation. The letter should also include all the information required to enable the user to undertake the support planning themselves or with the support of family/carers. It is critical self support options are promoted and enabled through this communication. a. The users will then advise the local authority which approach they wish to take to developing their support plan and confirm they are comfortable with the process and understand what they need to do. b. For individuals who are not able to complete their own support planning the local authority will provide support through the relevant commissioned service (in house, 3 rd party, voluntary sector) - 11 -
c. Additional internal processes will need to be established to capture the information from externally developed support plans onto LA systems d. Not everyone is able to manage their care or budget without assistance, an example matrix to help identify the differential support needed for people who may lack capacity to make some decisions is included at Appendix 2 4. Once plans and budgets have been confirmed and agreed with the individual, the authorisation of those budgets and implementation of services and care required will be initiated 5. The broker oversees the rollout of the Support Plan if required to do so by the user. Operationally, this means that broker ensures that services or products, including Direct Payments, are commissioned within the terms of the Support Plan a. Consideration must be given to an individuals capacity to mange the money, an example process map developed by LB Barnet on how to administer direct payments for people without capacity is included at Appendix 3. - 12 -
Appendix 1 12 Key points for professionals when working with carers. Personalisation can provide individuals, carers and families with more choice, more control and more flexibility in the way that care and support are provided. Personalisation and a whole-family approach are complementary it is important to look at a family s needs as a whole but also to make sure that individual carer s and user s views are sought and cultural expectations are clarified when considering how best to support a family. No assumptions should be made about a carer s ability and willingness to care. A whole-family approach is particularly relevant where young carers and inter-generational carers are involved but service users and carers of all ages can benefit from an integrated and holistic approach to providing personalised care and support. The twelve points below are designed to help professionals be clear about good practice in putting personalisation into practice when working with carers. 1. Professionals should routinely ask individuals whether they have people who provide care and support to them, and who may need to be involved in the support planning process. This ensures that valuable resources to support an individual are included at an early stage in the process 2. Professionals should routinely ask individuals for consent to share information with their carers and family. Any information on restrictions should be given to the carers at the earliest opportunity, to avoid misunderstandings. 3. In the majority of cases, individuals will be happy for carers and family to be fully involved and informed about their needs and circumstances. When this is the case, carers should be treated as partners in the support package. 4. Professionals can speak to carers and receive information regarding an individual without breaking the individual s confidentiality. 5. While confidentiality is a vital element of work with individuals, it should not be used as a barrier to communicating with other members of their network. 6. Carers are most likely to know important details about a person s support needs. 7. Carers must be consulted on best interests if the person lacks capacity to make a decision themselves, unless there are exceptional circumstances when the person is not appropriate to consult (Mental Capacity Act s4(7)). 8. Carers views must be taken strongly into account when deciding upon best interests, but they must be informed that they are not the decisionmaker (unless they hold specific authority, such as Attorney or Deputy) (Mental Capacity Act Code of Practice 5.8). - 13 -
9. Carers often need support to satisfy their own needs while fulfilling the caring role. A carer s assessment should always be offered, to enable these needs to be explored 10. When assessing carers needs, it is important to ensure that these elements are covered (this list is not exhaustive) a. What does the carer do to support the individual? b. What impact does the caring role have on the carer? i. This can include physical, emotional, psychological and employment issues ii. It often also entails positive feelings, of caring for a loved one c. Does the carer feel able and willing to continue to undertake this role? d. What support does the carer need to continue to manage? e. Is the carer competent to fulfil the role? (Do they need training in lifting, or using equipment such as a hoist?) f. What contingency and/or crisis plans need to be put in place in the event of the carer suddenly being unable to continue to provide support? 11. When a carer is involved with the support plan for an individual, their role in the support plan should be clear and unambiguous, and they should be given a contact point if problems arise. 12. If there is concern regarding the abuse, neglect or exploitation of an individual, investigating professionals should be honest and open with the carer, unless there are exceptional circumstances where the individual may be at risk of immediate harm. - 14 -
Appendix 2 Capacity, support and review matrix The ability to direct and manage one s own care and/or personal budget is a vital element of a personalised service, and enables individuals to maximise the choice and control they can exercise over the support provided to them. Not everyone is able to manage their care or budgets without assistance, due to impaired mental capacity. Some people will be able to manage these elements with additional help, while others will be too disabled to make any of these decisions themselves. If a person lacks capacity to make decisions, they are put at increased risk of abuse, exploitation or neglect and it is particularly important that sufficient support is provided to ensure that the person is safeguarded from these risks, and also is able to keep as much control over their support as their condition permits. Some people have family, carers or friends who can provide that additional support to ensure effective management of the support plan, while other people will not have people available to them. It is important for the [local authority] to be clear about the abilities of the individual and their network in order to understand what and how much support is needed, and from whom. Where mental capacity is in question, an effective assessment of capacity is necessary at an early stage, with appropriate reviews built in, dependent on the particular circumstances of the case. The matrix below provides a guide for the different levels of ability or difficulty that a person may experience due to issues of mental capacity. It is designed for guidance only, as every person s circumstances are different. The sort of support that may be needed depends on the abilities of the individual, and the level of monitoring necessary to ensure effective support will depend both on the individual and their network. - 15 -
Degree of difficulty Additional support needed Level of monitoring Fully able to manage care and budget Able to make decisions with support: family or friends available Able to make decisions with support: no family or friends available Able to direct care but unable to manage finances: family or friends available Able to direct care but unable to manage finances: no family or friends available Unable to direct care or manage budget: family or friends available Unable to direct care or manage budget: no family or friends available Significant fluctuations in capacity over time Good quality information Confirmation with client which person or people will be available to assist Work needed to establish who is available and appropriate to help the client make relevant decisions Assessment of willingness and competence of suitable person needed. Is Power of Attorney (PoA) or Lasting Power of Attorney (LPA) or deputyship needed? Work needed to establish who is available and appropriate to help the client make relevant decisions. Is deputyship needed? Assessment of willingness and competence of suitable person needed Identification of who will ensure client is kept involved in process, and wishes and feelings are always considered Specific contingency plans needed related to the particular likelihood, frequency and speed of fluctuations Low Low/Medium (initial monitoring of ability of others to provide effective support?) Medium Low/medium (initial monitoring of ability of others to provide effective support?) Medium Financial monitoring particularly important Medium (initial monitoring of ability of others to provide effective support?) High Needs specific decision based on individual circumstances - 16 -
Appendix 3 London Borough of Barnet: Procedure for Direct Payments for people without capacity Is there an attorney (under valid Lasting Power of Attorney) or a deputy appointed by Court of Protection? Yes Is the representative willing, capable and otherwise appropriate to act (as determined by Social Services)? The representative must make an informed decision and understand the role. That person is a representative appointed by the Court or under a Lasting Power of Attorney to handle financial issues. (The representative may also be appointed to cover welfare decisions) No Yes The representative would normally be first choice suitable person. No The court has not appointed anyone and there is no lasting power of attorney No Does the power of attorney or deputyship cover welfare decisions? Yes That person is a surrogate Does the surrogate consent to the appointment of someone else as a suitable person Yes No No No Is there an alternative person (or people) willing to act as a suitable person? (Social Services need to identify alternative person or people.) Yes Is that person capable of managing a direct payment and otherwise appropriate to act? [The person must make an informed decision and understand the role and agreement] Yes That person is a suitable person Is there a person (or people) willing to act as a suitable person? [Social Services need to identify person (or people)] No That person is a suitable person Yes The following people should be consulted and their views taken into account before deciding to make the decision to make direct payments to a suitable person: Anyone named by the service user before losing capacity as someone to be consulted. Anyone engaged in caring for the service user. Anyone with an interest in the service users welfare Any reasonable steps to ascertain the wishes of the service user. Any representative (even if they are not going to take on the role) Is that person capable of managing a direct payment and otherwise appropriate to act? [The person must make an informed decision and understand the role and agreement] Yes That person is a suitable person - 17 - No No suitable person available therefore you cannot proceed with direct payments.