Stories of success in support planning: Wiltshire Centre for Independent Living
We’ve been on a road trip, to see where people are having a better experience of support planning in our quest to find creative and diverse ways of managing personal budgets. Are their experiences improved when they aren’t all carried out in by statutory social work led assessment teams? This article describes what we found in Wiltshire where the council has contracted with the Centre for Independent Living to provide support planning for people taking up a direct payment. We found that a trusted partnership and willingness to work across teams resulted in better outcomes for the people we met.
Something good is happening in rural Wiltshire. People are being supported in a person-centred way.
Wiltshire Centre for Independent Living (CIL) is an organisation led by disabled people. It helps people needing care and support to understand the wide range of choices available to them, and to plan their support.
What’s more, Wiltshire Council pay Wiltshire CIL to do this for people taking a Direct Payment. Together, they are bucking the trend away from investing in disabled people’s led organisations and the dominance of council statutory assessment teams writing care and support plans.
At TLAP, we wanted to understand more about this and what the benefits might be both for people accessing services and the organisations involved. How did this start? How does it work? What are the key ingredients? What do people say about it? Does it work for everyone? Where might they be going together next? So we visited them earlier this year to find out more.
How did this start?
Geraldine Bentley, Chief Executive of Wiltshire CIL, told us about their journey; from set up by a group of disabled people, largely run on a voluntary basis for five years, to a small amount of money in 2010 that enabled them to employ Geraldine, an office manager and peer support worker. They bravely bid for a Direct Payment Support Service contract tendered by Wiltshire County Council in 2012. At the time they didn’t expect to secure the contract, but were delighted when they did.
They recognised they weren’t ready to take on some elements of the contract from another provider, so they talked to the commissioners about the practicalities of transitioning for people. This gave them time to develop their IT systems and to smooth out organisational transfers for workers.
Across the county the CIL now supports over 2,000 people in receipt of direct payments which includes a banking service for around 500 people, payroll service for around 400 people and the all-important support planning.One element of the contract that the council put out to tender was support planning for people taking a Direct Payment.
How does it work?
A trusted partnership with the council is the fundamental building block. This enables a flow of around 500 referrals a year from assessment staff, underpinned by the alignment of IT systems, with Wiltshire CIL’s support planning team having appropriate access to assessments on the council’s Carefirst system.
The support planning team is made up of four practitioners and their manager, Mary. Two of the planners are disabled people. Wiltshire CIL use a values-based approach to recruitment, actively encouraging people with no prior experience of social care to apply. They value the importance and commitment to the ethos of a user led organisation.
At the heart of the approach are strengths-based conversations focused on circles of support, coupled with reflective practice. One key question is used consistently in both elements: ‘how is this helping the person live the life they want?”
We were privileged to meet some of the beneficiaries of the team’s work, Debbie and Miasha. They talked about building a trusted relationship with the support planners -one that didn’t end when the support plan was written.
A deep understanding of person and community-centred approaches has been developed, starting with person centred planning training from Helen Sanderson Associates. Documentation started with tools this provided, but co-productive work between the team and the people supported stripped this back to a set of paperwork that suited everyone.
In addition, there is a focus on independence and outcomes. Where possible and appropriate this means working with people to reduce reliance on paid support. Miasha needed to attend health appointments. Her community psychiatric nurse’s solution was to arrange Community Transport to pick her up, but there were issues when this broke down. Poppy’s (one of the support planners) response was to work with Miasha to encourage and enable her to gain confidence to use public transport, which continues to work well.
The team’s interactions with people vary. It is fairly intense initially but they also focus on reducing reliance on practitioners as well as paid support: ‘we back away-it’s our ethos’. A coaching rather than therapeutic approach helps them work with people to change mindsets from ‘I can’t do things’ to ‘I can do things’. They often find themselves reframing relationships between professionals and people: ‘people defer to professionalism – we are always pushing back against this’.
What are the key ingredients?
Wiltshire CIL believe they have developed their trusted relationship with the council into one of ‘critical friend’. This ranges from strategic partnership work with social care and health through to collaboration on individual cases.
They believe their work is changing the mind set of people involved at all levels and within all functions at the council about what is possible and how the system can be shifted. Their view is that the system currently encourages people to spend the budgets they have been allocated on the kinds of care and support the system would expect, but they are helping a shift to more diverse solutions designed by people themselves which often cost less.
This is not an easy journey. Openness encouraged by council staff, like Pete Twiggs, Head of Operations at Wiltshire Council, has resulted in the CIL support planning team attending social care team meetings and chairing the Direct Payments Leads Forum. This is a place where issues are actively addressed case by case, issue by issue. Pete says ‘there is something about someone independent from the Council helping people build a plan’.
Pete notes the critical friend role works both ways, and there is healthy and open dialogue about what is and isn’t working in both organisations with a view to improving it for people. He says it’s not always possible for council assessment staff to have the time to support plan in depth with people in the way that independent people like Wiltshire CIL can.
What do people say about support planning in Wiltshire?
We were fortunate to hear directly from Debbie and Miasha about their experiences.
Debbie is a professional woman, a single mother and very independent. A recent diagnosis of late onset muscular dystrophy changed her life overnight.
She says Wiltshire CIL were a godsend. As Debbie’s condition fluctuates, it was very important that the plan was similarly responsive to these fluctuations. Abbie - Debbie’s support planner - dealt with all the necessary interactions with the council to ensure this did not become a stress for Debbie. The last plan they made together was discussed over a coffee in the local Costa.
In advocating for Debbie, Abbie made sure there was consistency and continuity of what she needed and that her preferences were respected in being supported. They found that there was much inconsistency and little continuity in the professionals involved from other agencies.
Debbie is so taken with the support she’s had from Wiltshire CIL that she’s now preparing to volunteer for them when she is physically and mentally able.
We also listened to a conversation between Poppy and Miasha, a real privilege. Many professionals have worked with Miasha, in her view unsuccessfully. The relationship with Poppy was different from the outset.
Getting out of the house is a real victory for Miasha. She described the way Poppy uses technology (a mobile phone!) to offer her a different perspective about things, and recognised that sometimes it’s a good way to motivate her. Miasha described how working with other professionals wanted to focus on certain things Miasha didn’t want to do, but Poppy is different.
‘You’re understanding, you push me when I have to be pushed’. Poppy replied ’So I can read you really well’. Miasha agrees. Poppy says that she sees Miasha has recognised she has responsibility in the relationship whereas before, with other professionals, this wasn’t the case.
The things Miasha talked about felt like everyday activities: getting on a bus; going to the shops; feeling confident enough to use the cooker; being motivated to clean the house. Working with Poppy, her mindset has changed, that push from her has worked when it hasn’t from others. ‘I want other people to do everything for me – you won’t do that!’ Poppy responds; ‘we share our lives, we are invested in each other’.
Does this kind of support planning work for everyone?
It was very obvious that this level of support is only for people opting at the assessment stage to take their care and support as a Direct Payment. Carers too can benefit from independent support planning and this has been recognised by the council through a contract with Carer Support Wiltshire that includes support planning.
Wiltshire CIL extensively promotes their ethos across the county and have a range of projects aimed at supporting people to have a good life in strong communities. So they are aiming to reach more people upstream from the assessment process. If more people know about Direct Payments earlier on, the result will be that they ask for this option when they are assessed if eligible for support.
Where might they be going together next?
Wiltshire Council are ambitious about transforming health and social care. They recognise this will take time to deliver, and that there will be creases that need ironing out along the way. For example they have recently, like many places, revised their assessment paperwork to embed a strengths-based approach. Lining this up with their case management system, Carefirst, resulted in some glitches in referrals to Wiltshire CIL. Together though, their healthy partnership relationship means that such issues can be openly discussed and positively resolved.
Individual Service Funds are a hot topic for the next phase of the partnership. In this area both organisations hope they will enable many more people to benefit from the support of organisations like Wiltshire CIL and help people to get better outcomes from their care and support.
This is one of a series of case studies - look out for the next article on independent brokerage.