Thursday, 10 March 2016

West Midlands Individual Service Fund Action Learning Set

Present:

Heart of England Mencap;

Solihull

Warwickshire;

Telford and Wrekin;

Birmingham;

Coventry;

Wolverhampton;

New Directions Rugby;

Midland Mencap;

Age Uk Solihull;

Wolverhampton;

Herefordshire,

Herefordshire.

Helen Turner, Improvement and Efficiency West Midlands

Chris Howells, Centre for Welfare Reform

Winning Hearts and Minds

Addressing the question, ‘What does ‘good’ look like?’, group discussion indicated a common understanding of what benefits ISF's can/should offer across the board

  • More independence, more control
  • Social workers comfortable with what ISF can achieve
  • Safe and accountable
  • Sustainable, offering creativity and choice
  • Delivering greater independence and happiness for customer
  • Driven by service user outcomes
  • Shared risk between council and provider
  • Facilitate more offers into the market place and opportunities for micro provision

General agreement that ISFs are part of a system and culture change, not just a pilot and we should not use the term as ‘pilot’ can be seen as temporary before ‘normal service’ is resumed(we may need to test what systems will work best but language is important here).

Shared Learning

  1. Calderdale

Calderdaleexperience key points:

  • Did a lot of work in advance with providers and social workersand developed information for both public and staff about ISF's
  • Started working with a small number of providers and engaged with both users and staff
  • Cultural change,not a quick fix
  • Social value is a key component
  • Building community capacity through Community Builders and Asset based approach.

Link to Calderdale presentation

Wolverhampton and Warwickshire have similarexamples andSolihull aregoing to use Local Area Coordinators. Conclusions were that Case Studies really help to convince and justify. On Social Value for example,Derby have evaluated the Social Return on Investment of their Local Area Coordination – see

  1. Provider Events.

Solihull Council have recently held a series of market shaping events led by their director of commissioning in which they have signaled their intention to introduce ISF’s A total of 23 providers attended as well as council staff from procurement, finance, quality monitoring, social care practitioners and CCG's colleagues. There were short presentations about the developing local offer, the aim of which is to enhance prevention and wellbeing through improved information and advice, community development via Local Area Coordinators, and the introduction of more flexible outcome focused contracts (including ISF’s). The events generated a broad open discussion and there was a mostly positive response to ISF’s, particularly about the ability to be flexible and bank hours. The events were pitched very much as a shared journey and further shared learning events between providers and social care staff are being planned.

Pace of Change

Issues

Heart of England Mencap.

For us – leadership. For our trustee board this is a big shift. Some of our older carers do not want to take control of the money but newer carers do want to take control.

Warwickshire.

Social workers struggle to come toget to grips with outcome focused way of working. They are under pressure and think this will be more work, Asking providers to work with the service user to take on supportplanning wouldfree up social work time although providers are not currently allowed to take initiative and any flexibility is tied up in contracts. (NB not having to do the care and support planning has been a selling point in Solihull)

Wolverhampton

Looking at paying in advance and flexing personal budget over 3 months and with a view to it being over a 6 month in future. This will allow greater flexibility when care and support planning.Pre paid cards can satisfy some of the perceived risksSome councils already have ISF's in place but not badging it as such. 3rd party accounts are ISF by another name. Let's look at where we have already made progress

Midland Mencap.

Our trustees bought into In Control model pilot. Citizens are waiting for this to happen. Midland Mencap keen on going ahead with ISF’s and working closely with Birmingham on this. ISF’s have many benefits including coproduction,shared ideas and pooled budgets to make money stretch further

Herefordshire.

Should we be badging ISF 's as delivering savings? There will be savings generated from streamlining systems and processes For example, pre-paid cards save time and money on unscheduled reviews by allowing provider to change the support, working to connect people more into leisure services and other community support there are examples from Midland Mencap of pooling budgets. But savings are not up front and not immediately cashable.

Coventry.

Have discussed with some providers, but they appear more concerned about their capacity to deliver on current services.

A general issue was how can we make ISF’s and flexible contracting work for older adults? Smaller packages may mean less creativity and Age UK Solihull's experience is that there are often no support plans or fewer plans in place for older people. Older people want reliability, consistency and to be able to change packages of support, just like any one else. Calderdale's examples are useful here as a reference. (See above).

Warwickshire, Coventry, Herefordshire and Solihull are all looking at a Domiciliary Care retender plus outsourcing reablement work (for some) and are looking to include ISF’s as part of this retender. It was clear that everyone is at a different stage but key messages were

  • trust your providers to deliver, this will
  • free up your time, and
  • work with the willing to begin with.

Solutions

Strategic Commissioning- Are ISF’s in your Market Position Statement? If they aren’t, include them. Develop a process and be clear about responsibilities

  • Social care staff complete needs assessment, determine eligible needs, generate an indicative amount of personal budget to meet eligible needs and a high level support plan based on outcomes then pass this to
  • the Provider to develop the detail and have creative conversations with the users. Note that Warwickshire have developed a high level process map for explaining where ISF’s fit within customer journey.

TLAP resource on Delivering Care and Support planning is a useful reference here.

Telford Wrekin and Herefordshire. Councils have the flexibility to commission more outcome focused contracts. Dynamic purchasing systems - Light touch regime allows commissioners the flexibility. Need to make use of it.

http://www.local.gov.uk/documents/10180/7519026/lg+procurement+-+National+social+care+category+strategy+for+local+government/dc65f5a4-5c2d-4ba4-92c7-a25b8f58fa09

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/469057/LTR_guidance_v28_updated_October_2015_to_publish__1_.pdf

Midland Mencap has developed a dash board of performance information that councils can interrogate remotely. This was for Carers contract. What information do councils need? They need to trust providers to manage this better.

Several councils have been involved in discussions with audit re ISF’s and electronic monitoring, predominantly only used for older adults services. How do councils and providers work together to have an auditable system for ISF’s? CM 2000 has an ISF module that monitors delivery over a period of time. Or will pre paid cards do this anyway?

Several councils may wish further discussion reaudit and role of CM 2000 - Wolverhampton Coventry, Solihull, Herefordshire.

Payment Methods

Shared learning from Wolverhampton. How pre paid cards can help deliver ISF’s?

Wolverhampton is working successfully with a pre paid card provider, PFS,to deliver on Direct Payments and there are now plans to extend this into Individual Service Fund delivery.

The company has just delivered a demonstrationfor providers and council officers to show the capability of the system. Providers have a pre paid account which is visible to them on line plus access to a helpline. Within the provider account individual accounts are set up for each service user and payments are made in accordance with the individual personal budget. There is the flexibility for theaccount topay other services such as leisure services, micro providers. It can also pay out cash. The provider can access the system and view it as can the council. Plus there is no cost to the provider.There are still some questions to be asked: Can service users view their account information? How can customers with fluctuating needs be managed within the system? but most thought that this prepaid provider system offered good flexibility and protection for all.

Birmingham is also going down the Pre paid card route and are about to chose their provider.

Brent have been using pre paid card with ISF's already.

Types of Agreements(2 way vs 3 way agreements)

Warwickshire. Initially going with a 3 way agreement as that is what they have developed and don't want any further delays. They have identified 2 clients with Heart of England Mencap who will move across on to an ISF but are looking to move to a 2 way agreement at end of 6 month pilot.

Wolverhampton are paying provider gross on a 2 way agreement. They have a good debt collection team and slick financial process which mitigates the need for detailed audit processes.

Most councils are looking at a 2 way Agreement and the consensus was that this is definitely the preferred route.That is a 2 way Council to Provider and a 2 way Provider to Service User. Centre for Welfare Reform has an example Council - Provider agreementon the website

and Birmingham have used it as a framework for their approach.

Midland Mencap agreed to send through a copy of an agreement between Provider and Service User.

Provider Role

Heart of England Mencap

Sees ISF’s as a strategic route moving forward. Recognise the value of people having personal budgets as it gives people the opportunity to connect more with their communities. Provider can/should facilitate this connection but have to make a shift in the way care is delivered. Most importantly, Councils need to start the dialogue with providers

Midland Mencap

Tested out lots of principles in the past. People have brokered what they want already so the ISF approach is now new. Noted that Transport is an expensive part of care plans and asked the question how best to broker and share taxis to make the budget stretch.

New Direction, Rugby.

This is a great opportunity to help people make more changes. There are challenges for care staff as ISF requires a different culture for support. Those that have a time/task approach will need to develop and use their initiative as this is a cultural shift. Noted that the impact of national living wage makes it a difficult time to be recruiting staff with the right approach to care under ISF.

Next Steps

Is the Action Learning Set useful? Where next?

Feedback was that it has been extremely useful to share views and make connections.

Work streams that people are interested in:

  • Working with Procurement
  • Role of Pre paid cards / CM 2000
  • How do you sell ISF’s? Communications and case examples
  • Getting buy in from social care staff - involve social workers in next ALS
  • Leadership – Helen and Chris to attend West Midlands Councils Strategic Commissioning Network. Date in May
  • Levering change locally- Herefordshire would welcome some external(neutral) input.

Helen Turner

Social Care Insights Ltd

Associate to Improvement and Efficiency West Midlands

Chris Howells

Koru Consulting Ltd

Fellow, Centre for Welfare Reform

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