Self Directed Support
PERSONAL BUDGET PROCESS GUIDE – Updated 01.04.2010
Introduction
SDS Process
Who is eligible for Self Directed Support in Lancashire?
How do we count people as being in receipt of Self Directed Support?
Self Directed Support Target
Telling People About Self Directed Support
SDS Flowcharts
STEP 1 – ASSESSMENT AND COMPLETION OF THE SELF RATING QUESTIONNAIRE
What is a Self Rating Questionnaire (The SRQ)?
When to issue the SRQ to the service user/carer
How to complete the SRQ
Staying Safe
Health
STEP 2. AGREEING THE INDICATIVE BUDGET
What is an "Indicative" Budget?
How the Indicative Budget is calculated?
Applying the Resource Allocation System (RAS) to establish the Indicative Budget?
STEP 3. SUPPORT PLANNING
What is a Support Plan?
Who completes the Support Plan?
STEP 4. VALIDATING (AGREEING) THE SUPPORT PLAN
What does a good Support Plan look like?
How to cost a Support Plan
How to validate a Support Plan
STEP 5. DECIDING HOW TO MANAGE THE BUDGET &
IMPLEMENT THE PLAN
STEP 6. ONGOING SUPPORT
STEP 7. REVIEW
What to do at the initial review stage
What to do at a scheduled review
What to do at an unscheduled review
Glossary / Jargon Buster
How you can get more help with Self Directed Support Cases/Problems?
What is being done to adapt IT and other key systems for Self Directed Support?
APPENDIX 1
Mental Health Guide to Self Directed Support - Personal Budgets
APPENDIX 2
Establishment of Support Plan Resolution Groups
APPENDIX 3
Charging Policy in relation to Self Directed Support
Personal Budgets Process Guide
Introduction
This guide aims to help you through the process for setting up a personal budget for people using Self Directed Support.
The guide sets out an interim process for using Self Directed Support which will apply until our systems and processes have been fully adapted to take account of Self Directed Support.
We don't want to let systems issues stifle enthusiasm for offering people more choice and flexibility through Self Directed Support. This guide will help you to work around some very practical problems that the current system presents us with and enable people to self direct their support.
Keeping Self Directed Support Safe
See link below for guidance which outlines the process for Self Directed Support and provides evidence of how safeguarding of both the people we support and the public money we manage is integral to what we will do at each stage of the process, from assessment through to review.
http://lccintranet/acs/groups/self-directed-support/guidance/guide.asp?siteid=4833&pageid=24169&e=e
SDS Process
There is a full process flowchart at the beginning of the guide (see page 4 onwards) with guidance notes relevant for each step at the back (see page 10 onwards).
There is also an SDS site on the Lancashire County Council Website which is regularly updated. Updates are notified in Change Matters.
http://lccintranet/acs/groups/self-directed-support/
A short staff guide is available on the SDS site which is updated regularly.
Personal Budget - Short Guide (35 KB, Word Document)
Separate Guidance is available for Mental Health Teams (See appendix 1)
Who is eligible for Self Directed Support in Lancashire?
Everyone who is assessed as eligible under FACS criteria should be considered for a personal budget under our Self Directed Support Policy except for:-
· People whose assessed need requires an emergency or crisis intervention. (Immediate needs can be met via conventional services and Self Directed Support should be considered later when the crisis has passed)
· People whose liberty to arrange their care is restricted by certain Mental Health or Criminal Justice legislation. The regulations relating to exclusions from eligibility for Direct Payments have been updated with effect from November 2009 and are now more inclusive. See Direct Payment guide.
· People whose needs can only be met by a Care Home placement. (Lancashire may consider extending access to Self Directed Support for people in residential settings at a later date)
· People who qualify for full Continuing Health Care Funding. (It is not currently legal for health to offer Personal Budgets, although this may change in the future)
How do we count people as being in receipt of Self Directed Support?
The Government has defined the 3 criteria for counting people as "Self Directing"
1. The person (or their representative) has been informed about a clear, upfront allocation of funding, enabling them to plan their support arrangements,
2. There is an agreed Support Plan making clear what outcomes are to be achieved for the money,
3. The person (or their representative) can use the money in ways and at times of their choosing.
Self Directed Support Target
The Government has set Lancashire a challenging target in terms of the numbers of people Self Directing their Support. By the end of March 2011 we aim to have 30% of all adult service users and carers accessing non residential services through Self Directed Support. This means that based on estimated projected numbers of people we will support, we aim to help 10,777 service users and carers to access Self Directed Support by March 2011.
Consider the cases that you are working with (or allocating/supervising if you are a team manager) who meet the eligibility criteria for Self Directed Support that could immediately benefit from a Personal Budget. Experience to date indicates that people who are new to our service, people who require ongoing support following support from transitional services, people already in receipt of a direct payment and people who are being reviewed are best placed to start self directed support. You may also be working with a challenging case where you think a better outcome might be achieved if the person was able to access more control and flexibility with their support arrangements.
Telling People About Self Directed Support
There is a Public Information Leaflet on the SDS Internet Page. Thisdocument explains what SDS is, how SDS works, support peoplecan haveand how people can arrange SDS.
http://www3.lancashire.gov.uk/corporate/atoz/a_to_z/service.asp?u_id=2806&tab=20
There is also an SDS DVD available which features stories from 6 people in Lancashire and the impact Self Directed Support has had on their lives.
GUIDANCE NOTES
STEP 1 – ASSESSMENT AND COMPLETION OF THE SELF RATING QUESTIONNAIRE
What is a Self Rating Questionnaire (The SRQ)?
The Self Rating Questionnaire (SRQ) is a short form which is used to establish a points based score in relation to the needs of an individual. This score is linked to an allocation of funding. The SRQ and related guidance is on the Self Directed Support intranet website.
http://lccintranet/acs/groups/self-directed-support/resources/details.asp?siteid=4832&pageid=24475&e=e
The SRQ can be completed by an individual and/or their carer or with the help of a Community Team member, a Broker or anyone else they may choose to help them.
When to issue the SRQ to the service user/carer
Experience to date leads us to recommend that where possible the SRQ is best completed TOGETHER with the individual, their carer (if appropriate) and the caseworker, using information from the overview assessment to inform the process. This provides more opportunity for the caseworker to explain each domain in detail and to help the individual determine the most appropriate score for themselves or come to a satisfactory compromise where there are any differences of opinion.
A judgement needs to be made by the caseworker as to whether to issue the SRQ in advance of the visit to allow the person time to consider how they may rate themselves.
The Resource Allocation System (RAS) funding levels should not be issued to individuals without permission from your Team Manager. Experience to date has shown that issuing RAS levels distorts the assessment process which should focus entirely on actual needs. (For more information on the RAS and funding levels see Step 2)
How to validate an SRQ?
To validate a SRQ the caseworker needs to consider the information from their own assessment/review and compare this with the information in the SRQ. For example if the caseworker’s assessment concludes that a person has significant personal care needs then you would expect the person to score appropriately in the personal care section of the SRQ.
If there are discrepancies between the caseworker’s assessment and the information on the SRQ then this needs to be negotiated before the SRQ can be considered to be "validated". For example if the caseworker’s assessment concludes that the person is able to stay safe with the help of an existing community alarm system but the SRQ states that the person needs support 24 hours a day to keep them safe, then this issue needs to be negotiated by the caseworker before the SRQ is considered to be "validated".
In the unlikely event the caseworker and the individual /carer are unable to negotiate agreement on the scores in the SRQ then the case should be discussed with a Team Manager who will advise on how to proceed.
How to complete the SRQ
There is more detailed guidance on completing the SRQ within the document itself the most up to date version can be found on the SDS intranet page.
Different interpretations of the domains will lead to incorrect scoring which can lead to a significant difference in indicative funding levels. It is important that 'double scoring' is avoided.
This is how the domains Staying Safe and Health should be interpreted and applied during the assessment process.
Staying Safe
Scoring in this domain is fundamentally related to an individual's support needs which are usually related to their behaviours, rather than other needs such as personal care or health which are scored in other domains.
A score of 30 (Very High) is only appropriate where it is assessed that an individual requires very intensive support at a level which would necessitate a constant physical support presence 24 hours a day because they cannot be left unsupervised at any time.
A score of 15 (High) would still assume comprehensive support needs but where these could be met with a background support presence close at hand if needed but not necessarily a constant physical presence.
Health
This domain relates to an individual's support needs in relation to helping them staying healthy. The starting point should be the question of "are the individuals needs being adequately met through the local primary care team or other health care service?" This is likely to apply to the many of those being assessed and a subsequent score of nil should be recorded. Caseworkers should still consider Continuing Health Care Eligibility.
This domain should only be scored when support is needed to manage a long term health condition "over and above" the support obtained via NHS services.
To score high in this domain would indicate that an individual would need intensive/constant support to manage their long-term health conditions (i.e. those conditions that cannot, at present, be cured, but can be controlled by medication and other therapies) on a 24 hour basis. This does not relate to behavioural needs which are scored under Staying Safe as explained above.
STEP 2. AGREEING THE INDICATIVE BUDGET
What is an "Indicative" Budget?
An indicative budget is exactly that, i.e. it is purely an indication of the amount of money a person may need to plan their support with. It may be that after the Support Plan is finished the actual amount of money needed to meet the person’s needs might be less, or about the same as the indicative budget. In some circumstances it may be necessary to consider an amount that exceeds the maximum indicative budget. The indicative budget is just a guide to help people to begin to plan their support.
How the Indicative Budget is calculated?
The indicative budget is calculated using the scores from the Self Rating Questionnaire (see step 1 above) and applying the Lancashire Resource Allocation System to this score.
Applying the Resource Allocation System (RAS) to establish the Indicative Budget?
The Resource Allocation System is a tool that converts the points scored on the Self Rating Questionnaire into an indicative budget. The current Resource Allocation Tools are available via our SDS intranet site.
Lancashire currently has two Resource Allocation Systems. These are available at
http://lccintranet/acs/groups/self-directed-support/resources/details.asp?siteid=4832&pageid=24476&e=e
RAS1 should only be applied in cases where the individual needs a support presence on a 24 hour basis, either in the background or possibly on a more intensive 1:1 basis. Typically the support needed would be provided within a 'shared tenancy model' not be available via a family carer or other informal sources
RAS2 should be applied in cases where the individual needs support at key times of the day but generally not on a 24 hour basis, or, in cases where 24 hour support may be required but a significant amount of this can be provided by a family carer or other informal sources. (This is the RAS that applies to most people living in their own homes)
There are some difficulties with the current Resource Allocation System (RAS), which can result in an indicative budget which does not appear to reflect individual needs e.g. the RAS does not take into account situations where two carers are required to perform certain tasks such as transfers, and/or or take into account informal supports.
· Two Carers
Where an individual requires two carers to ensure their needs are met, the support plan should provide the details of those tasks requiring two carers highlighting the need for an actual budget in excess of the indicative budget.
· Informal Supports
The Support Plan should take into consideration the informal supports that an individual already has and providing that these supports are reliable, able and willing, then we should not be replacing with paid formal care hours. RAS 2 indicative funding levels include any costs of carer's multi vouchers or Direct Payments in lieu of multi-vouchers.
It is important to record details of informal supports within the support plan.
STEP 3. SUPPORT PLANNING
What is a Support Plan?
A Support Plan is the document that shows how someone’s Personal Budget will be spent and how their needs will be met
Who completes the Support Plan?
Individuals can choose to do their Support Plan themselves or with the support of their choice e.g. friend, family, carer, social worker, RASO, Reablement Officer (If it is a caseworker this should ideally be the same person who completed the overview assessment).