Working from the person outwards - commissioners, providers and Individual Service Funds
I recently had the pleasure of talking with a group of people working in Health and Social Care in Wigan who are really trying to transform the offer of social care support in the town. They want to use Individual Service Funds (ISF’s) to help make this happen.
The focus is on their contracted Home Care services. There is a real desire to do something different to make sure people who use services can truly self-direct their support, be in control of it and have choice. Wigan’s ‘ethical framework’ of providers includes Making Space who are working with Wellbeing Teams (the providers) to pioneer the work in partnership.
Innovative commissioner Jo Wilmott is leading the way through ‘learning by doing’, supported by other Council leaders from Health, Adult Social Care and Communities. Keeping it simple is also important. Can business be kept as usual as possible?
One of the most striking things was the open-mindedness and optimism about what could be achieved. No preconceptions about the detail, just a strong understanding that by using ISFs, things could be really different in a positive way, and a strong sense of knowing that ‘if we do this here, it will impact there’. Demonstrating the impact of the ethical framework and the use of ISFs will be key to success and wider system buy-in across staff in different service areas in the Council and Health.
Our first discussions involved people who currently manage key functions within the ‘system’ and we agreed to try three things.
1. Looking at the output of social care assessments and the detail that goes into care and support plans. We agreed this should include at high level:
• an indicative budget, which Wigan’s locally designed resource allocation system does perfectly well
• a care and support plan that frames need assessed as eligible for funding in high level outcome terms
• an agreement that Wellbeing Teams will manage the Personal Budget and provide the flexible support to help the person achieve the desired outcomes on an ongoing basis. In other words, a pure implementation of an Individual Service Fund.
2. Improving communication between assessment staff, and other people within statutory organisations that collect and maintain information about the person being supported and Wellbeing Teams. We agreed this should be open, transparent and focused on working together in a person-centred way in the interests of the person being supported, in ways that make sense to them. We will try:
• passing on details securely that are captured within assessments and care and support plans. These often don’t reach providers, even though they are contracted. This includes rich detail from person-centred thinking tools embedded in Wigan’s assessment form and skilfully gleaned by practitioners; from key relationships with professionals and from a circle of support making contributions by carers, friends and families.
• focusing on delivering outcomes rather than a specification of tasks and a schedule of timed visits
• the payment of an allocation of funding for the individual, and a shift for the provider in their recording systems to line up with a focus on the achievement of outcomes. This will be quality assured by the person being supported. Wigan is going to start by rolling up the number of hours that would have been bought in ‘old thinking’, paying this one week in advance and creating a regular weekly advance payment. This will help the Wellbeing Team work within a financial envelope to deliver support flexibly and meaningfully for the person.
3. A different approach to reviewing how well things are going. We had to check the Care Act guidance because no-one was sure whether specific timed cycles for reviewing are stipulated. We discovered that they’re not, so there was a healthy discussion about what might make sense. We will test:
• building trust across all parties in order to learn and giving sufficient scope for flexibility. That means banking of support targeted and earmarked for milestone purchases if so desired. Everyone felt comfortable in moving from a practice norm of a six week initial review out to a twelve week ‘check in’. This would see how things were going, assess progress in the achievement of outcomes, as well as quality assurance of how well the Wellbeing Team were doing from the perspective of the person being supported.
• Discussion will centre around how the outcomes have been achieved and through the kinds of activity and number of visits, rather than counting the specific number of minutes that have been spent at each visit.
• Importantly, it was felt that the person being supported should decide who would be present and input at the review, and this should naturally include the Wellbeing Team members working with the individual.
I’m looking forward to return periodically to Wigan to see how things are going, helping them to reflect on the progress they are making and acting as a point of reference about the positive practice that has developed around ISF’s in the last couple of years. And we’ll be hearing how things are going from the perspective of the Wellbeing Teams.
Self-Directed Support is looking healthy in Wigan. How’s it looking where you live and work?