Trust, flexibility and just getting on with it...

Back in 2007, I had my first experience of how Individual Service Funds work in practice when working in the London region on personalisation. A London Borough invited me to come and meet some people they commissioned support for using ISFs with two different providers.

The first people I met were a group of 3 young women with learning disabilities who shared a house. They told me about how they lived their lives and the support they got to do this. What they described to me was a support provider that was person centred, creative and committed to listening to what people want and changing when the people they supported needed to change. They did not have a strong awareness of how the money worked but they definitely knew that they were in charge of how they were supported to lead their lives.

The person managing their support on the other hand, had a clear understanding of how the money was ring fenced around what individuals needed and pooled together to provide some shared support. The three women had opted out of local day services and were using their funding to go out to cafes, clubs and leisure centres and set up regular groups with other people. I was struck at how far they made their money go by pooling together and using what the wider community offered. The manager felt liberated to work around what the women wanted rather than a service model.

I questioned whether the provider could have worked in this way without an ISF and of course the answer was yes, but what the provider felt was a freedom to be flexible and change how they supported the women without having to have a meeting with the commissioner so they could just get on with it. What the provider described was a trusting relationship between them and the commissioner and between them and the people they supported.

Given that many commissioning, procurement and contracting processes are built on an assumption that commissioners and providers cannot trust each other, it is hard to build relationships based on trust within the way we currently work. ISFs offer a way to contract for achieving the outcomes people want in their lives, rather than a set of service related outcomes and what happens to achieve that is between the person needing support and the organisation supporting them.

I met with another provider working in the same local authority that had ISFs with two men with learning disabilities they supported. What struck me about this particular arrangement was that the staff operated in a way they would in any decent care home, they were kind and attentive but ultimately they were in charge, not the people they supported. Despite having ISFs and person centred plans, the manager and staff did not get the shift in power that was needed and neither did the people they supported. The ISF was simply an exercise on paper that changed very little in peoples lives.

So how does that fit with just letting providers and the people they support get on with it? Clearly there are providers that have made significant effort in shifting power and control to the people they support and are ready to go with ISFs and those that do not have the culture within their organisations to do this, or are trying to shift in that direction but not quite there. Working out what a good culture looks like and the difference between the organisations that have and haven't will be important for commissioners.

Focussing on outcomes in people's lives will also be central to getting ISFs right and contracts between commissioners and providers can be built flexibly around individual outcomes. It is also important to be clear that the ISF is just a small component of all of this and it is really about how we change how we run our organisations so that we fit around people, rather than them fitting into what we do. Working out the money can drive this change but is not the end point.

In 2007 I thought that ISFs would be the main mechanism for helping people to take control of their lives. The ADASS survey 2014 says that only 4% of people using community care services have an ISF with a provider. In a recent survey carried out by H&SA into the understanding and use of ISFs, 33% of respondents said that they did not know what an ISF with the majority of respondents being support providers and disabled people and families. The 66% of people that did know what an ISF is went on to describe differing arrangements. It's time to step up the development of ISFs and it is good to see the TLAP guidance that makes clear what ISFs and flexible contracting means and how we can develop it more.

H&SA has ISF Special Interest Groups where providers and commissioners are coming together to work out how best to do make ISFs work. If you are interested in more information, contact enquiries@housingandsupport.org.uk