citzen directed support - september 2010

of 24 Issue 3 September 2010

Citizen Directed Support Changing Lives Together

Welcome to our September edition of the CDS Newsletter. We have been very busy this month working with a small group of service users who are planning our next ‘event’ which is now scheduled for 6th December and will be an opportunity for users and carers to help shape the direction of the Transformation agenda. A number of us attended a conference this month organised by the Care Council for Wales which has commissioned a report outlining a number of recommendations for the future of the care at home workforce. Swansea was mentioned several times as a local authority that was exploring how future models of care and support may look like and we also hosted a workshop around ‘Outcome Focussed Home Care’. It was great to see that one of the five recommendations of the report was to ‘Explore the consequences for the workforce of new service options around self-directed support’. Both the Association of Directors of Social Services and All Wales Adult Service Heads have now got CDS as a priority within their workplans and I have been invited to attend a meeting in Cardiff to discuss the ‘Swansea TASS agenda’. We now have a project plan in place to drive forward the TASS agenda with a number of workstreams reporting into it. Progress will be reported directly into the Strategic Project Board in the near future and will be aligned to other Corporate Strategic Projects. During September we have presented the TASS workstreams to our Overview and Scrutiny Board who have shown a great deal of interest and have requested further reports. I have also presented a report to the Members Business Improvement Board this month - opening up a discussion on the options available for delivering adult social care in the future. An update will be included within the November TASS newsletter. Like all other authorities we are faced with tough times ahead financially but I am confident that our TASS agenda will help to ensure that our future models of care and support will be sustainable both now and in the longer term. Deborah Driffield Head of Adult Services

In this issue: Assessment & Care Management 3 My Home Life 6 Risk Management 10 Gorseinon Project 11 Gorseinon DP Event 16 RAS Workshop 17 Carewatch 19 Age Concern Swansea Case Study 22 Personalisation Event 23 Person Centre Thinking 23 Norton Lodge 24


Welcome to the third issue of Social Services’ newsletter focusing on Citizen Directed Support. One purpose of these newsletters is to provide progress reports and updates from the pilot projects in Swansea. The Time Together project in Gorseinon has been moving forward and gathering strength over the summer, and on page 12 we bring you the latest news. There is also an update on the work that is taking place in the area of Assessment and Care Management on page 4. The featured topic this month is My Home Life, an initiative which shows that the personalisation of services is not restricted to community-based services, and that care homes can also provide person-centred support. Disappointingly, we have had very little contributed by staff or service users since the last newsletter. Hopefully this is just because people have been busy with other things over the summer, and we’ll get more stories for the next newsletter. We are holding over the couple of short but positive examples we’ve had in until the next newsletter, when I hope we will have more to add to them. Please do send in your stories and questions for the newsletter, as everyone seems to enjoy reading about what’s happening around our different services. Remember we’re happy to include:

• Case studies of successful outcomes and/or community involvement • Personal stories from service users • Positive snippets of good news or innovative ideas (just a few lines is fine) • Useful hints or tips you’d like to share with others • Links to articles that you’ve found particularly useful or inspiring

Colleagues in independent sector and voluntary organisations are also very welcome to submit contributions. This newsletter includes an article sent in by Carewatch, a domiciliary care agency operating in Swansea, and a case study from Age Concern. Contributions for the October Bulletin are also very welcome – but remember that you need to get your message across in 120 words or less. (Not quite as short as a tweet!) Please get involved! If you have anything to contribute to a future newsletter – an article, a question, a tip, a link or even an idea for an article you’d like someone else to write – please contact the editorial team. Helen Barney 636902 [email protected] Angela Morgan 636414 [email protected]


The Revision of Assessment and Care Management Since the introduction of Unified Assessment, many frontline staff, service providers, service user and carers have expressed dissatisfaction with a number of aspects about the Unified Assessment process and system of recording. The Assessment has been seen as too cumbersome and process-driven, and we have been exploring ways of improving it to make it more person-centred. Assessment and care management in Older People’s Services was reviewed throughout 2009 as part of the SSIA supported ‘All Together Now’ project. This project focused on more person-centred and outcome-focused approaches to assessment and care management, a greater emphasis on relationships and dialogue rather than form filling and a recognition that assessment and care management was everyone’s business, working across the purchaser – provider ‘divide’. Building on this work, a series of pilot projects across Adult Services have been taking place since the beginning of 2010. This has led to a reappraisal of our approach to assessment and care management. The traditional assessment and care management cycle has been redesigned to cover the following stages: Stage 1. Opportunities for self-assessment and better signposting through web-based self-assessment tools, and supported self-assessment via the Intake Team. Stage 2. A strengthening of UA Domains 1 and 2, through person-centred thinking and outcome-focused conversations with users and carers. Stage 3. Working with families and communities to identify where natural networks of support can be supported and strengthened Stage 4. When appropriate, offering a period of reablement in order to maximise the independence of people in need of support, before carrying out a comprehensive assessment of longer-term needs. Stage 5. Ensuring the fair and consistent allocation of resources to meet people’s long-term needs following a period of reablement

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Stage 6. Holistic and person centred UA Support Plans rather than just Care Plans Stage 7. Positive risk management to support person-centred UA Support Plans Stage 8. More ‘join up’ between UA Support Plans and Service Delivery Plans by provider agencies Stage 9. Outcome-focused service user and carer Reviews, including feedback to contract monitoring and commissioning A workshop involving a wide range of senior and frontline staff, users and carers took place on 10th September to explore the associated forms, with an emphasis on eliminating duplication and keeping the process and simple and user friendly as possible. A draft set of documentation will be developed and piloted between October and December 2010, before the final draft will be used to revise Unified Assessment in PARIS in early 2011. We will bring you further updates on this important area of work in future newsletters. In the meantime, further details can be requested from Nick Andrews, Planning Officer for Older People.


My Home Life: Making Care Homes a Positive Option

My Home Life is a care-home-based approach to the growing move to provide more personalised services that focus on outcomes. A personalised approach is just as relevant to care homes as it is for those who live at home. My Home Life concentrates on how to build, realise and maintain a good quality of life for those who live, visit and work in care homes. It is a national movement, led by the care home sector and supported by AgeUK, City University and the Joseph Rowntree Foundation. It has a distinct Welsh strand – My Home Life Wales – supported by Age Cymru and Health Challenge Wales.

What is the aim of the initiative? My Home Life aims to improve the quality of life of people who are living, dying, visiting or working in care homes for older people through relationship-centred and evidence-based practice. It aims to work with the sector to develop a relationship-centred, evidence-based vision for care home practice, which communicates the expertise and vital role of care homes in the 21st Century. The intention is to: • help the care home sector to find its own voice • share and celebrate existing best practice • develop a shared agenda for improvement in the quality of care and

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• place care homes at the heart of their communities • promote care homes as a positive option for older people. How is this being done? Eight best practice themes have been identified. • Managing transitions • Maintaining identity • Creating community • Sharing decision making • Improving health and healthcare • Supporting good end-of-life • Keeping workforce fit for purpose • Promoting a positive culture A number of accessible tools to support managers, staff and commissioners have been created and are being shared via the My Home Life website. Alongside this a programme of activities for residents is being developed through the eight best practice themes. There is also a focus on promoting the Senses Framework to both residents and staff: • A sense of Security – to feel safe • A sense of Continuity – to experience links and connections • A sense of Belonging – to feel part of things • A sense of Purpose – to have a goals to aspire to • A sense of Achievement – to make progress towards these goals • A sense of Significance – to feel that you matter as a person What is happening locally? As part of the Transformation of Adult Services, colleagues from the Social Services Care Homes Team at the Civic Centre and the Commissioning Support Unit are promoting the My Home Life initiative in their work with care homes in Swansea. We see the application of My Home Life principles and good practice as an effective way of delivering the sorts of services our clients want and need. We are now looking at ways to encourage and incentivise more care homes to start working in this way. We also want to work with assessors, commissioners and regulators to make it clear that this is the model of service the Local Authority will judge as good performance.

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Under Stage 1 of the My Home Life Project a number of independent sector homes across the country signed up as pilot homes including, in Swansea, the Mumbles Nursing Home. Social Services has been working closely with the manager and staff there and hopes that the experience and developments at this home can be cascaded to other homes in the area. Liz Lovell from Mumbles Nursing Home made a presentation at the 2009 My Home Life Conference an event outlining some of benefits they have seen at their care home since adopting the My Home Life ethos. Some other homes in the area have already adopted the My Home Life approach and good examples of person-centred care can be found across Swansea and border counties. In a care home setting this centres on finding out about the individual resident, their past likes, dislikes and way of life and the experiences that have made them the person they now are, then working with them in the care home to try and maintain that identity. One home has adopted a This is Your Life-style approach to promote the use of life history and story telling. The resident’s life history is recorded and shared with others, promoting both reminiscence and getting-to-know-you. Another home, in Powys, has adopted the use of pet therapy. Very often former residents would have enjoyed owning a pet at home and dogs, cats and even a horse have been used by the home in different ways to develop a person-centred approach to care. At Ty Waunarlwydd the staff team have been developing relationship-centred care with a particular focus on those who have dementia. Along with Nick Andrews they have been asked to run a workshop on the topic at a My Home Life Cymru national event on 17th November. This workshop will focus on the application of the Senses Framework for residents, carers and staff. There is further information about the event at the end of this article.

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Using Volunteers One way we are hoping to promote this initiative is through the work of befrienders and volunteers, which we think is an area with considerable potential. Social Services hopes to link with a local agency that provides support to volunteers in order to develop this, and have also had some very positive initial discussions with Church groups on the potential use of their volunteers to provide much-needed support to residents of care homes. A meeting is planed in the autumn to look at how we can support local care homes to adopt the My Home Life approach and how volunteers can play a part in this. Promotion of My Home Life in Swansea Earlier this year Social Services held an event at the Provider Forum at the Dylan Thomas Centre. Providers all been very enthusiastic and receptive to the initiative and now further work is required on making it happen in all care homes. Nick Andrews had a stand there displaying the various resources that can be used in person centred care, such as life history books and talking mats and photograph albums, as well as the way dolls and toys can be used in work with persons with dementia A range of information has been sent out to all the care homes regarding My Home Life to encourage them to adopt the initiative. What does the future hold? My Home Life sees the key themes for the future as being:

• Helping the sector to find its own voice • A roll-out of My Home Life Local Champions • Improved Website and ‘Shared Space’ & resources • Professionalised, better supported sector properly integrated with

Health and Social Care • Care homes at the heart of the community with relevance to us all. • Care homes driving forward their own agenda for improvement • Building upon the energy, enthusiasm and best practice out there • Collaborating, sharing and realising a vision for change

Locally it is important that we work with Health. We have engaged with them, and indeed Swansea was only area to send a Health representative to the last My Home Life conference. But this is an area where greater co-ordination and joint working should produce real benefits.

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Social Services intends to work with the Care Home Managers Group to look at ways we can support them. This may include identifying and overcoming barriers setting up ways of sharing best practice and experience. The themes of My Home Life are likely to be to the future basis of how the Local Authority commissions for outcomes and upon which it bases its contract specification and monitoring to judge provider performance. Where to find out more A variety of resources that can support care homes to develop good quality care can be found on the My Home Life website www.myhomelifemovement.org. The My Home Life Wales website www.ageuk.org.uk/cymru/home-and-care/my-home-life-wales provides a Welsh context.

There is also a comprehensive set of short films illustrating the eight best practice themes on www.myhomelifedvd.org.uk

My Home Life Wales is holding a National Seminar on 17th November entitled Realising Good Quality of Life in Care Homes for Older People. It will take place at the SWALEC Stadium in Cardiff and will give practical examples on how to build, realise and maintain a good quality of life for those who live, visit and work in care homes. For more information contact Laura Jones, My Home Life Wales Programme Assistant Tel: 02920 431565 Email: [email protected]


Risk Management Identification of a risk should involve a balanced approach, which looks at what is and is not an acceptable risk. It should be a view based on a service user's aspirations that aims to support them to get the best out of life. We all take risks in our everyday lives, (examples below), and we need to be aware of the possible consequences of these.

• Driving too quickly/under the influence... • High-risk sports • Risky procedures at work… • Unprotected sex • Neglecting personal domestic security • Drugs/alcohol, sharing needles etc • Not taking medication • Unnecessary financial risks • Personal relationships etc

However, not every situation or activity will entail a risk that needs to be assessed or managed. The risk may be minimal and no greater for the service user than it would be for any other person. Where a risk assessment is needed, a decision then has to be taken about whether or not positive risk-taking is necessary to achieve certain outcomes for the person concerned (see below). It will not always be appropriate to take positive risks but this has to be determined in partnership with the person affected, and their family where appropriate Assessing and managing risk or safety should not be seen as negative. Managing risk is about making good quality clinical decisions to support and sustain a course of action that, properly supported, can lead to positive benefits and gains for individual service users. It should also be seen as a dynamic process which changes and adjusts along the continuum of care and which builds on the strengths of the individual.

Taking a positive approach to risk


Time Together (the Gorseinon Project) Time Together (or as it is more commonly known ‘the Gorseinon Project’) is now entering its operational phase after nine months of planning and developing the ideas that will make the project a reality. Representatives from across the Social Care sector have formed an Alliance that is determined to challenge and change the way we think about and work with people in their communities. The idea for the project is based on sound community development experience and the concept of ‘time banking’. We know that everyone benefits from living and working in vibrant communities where we all have a role to play. For people who may be vulnerable, isolated or in need of support this is particularly important. So the Gorseinon Project is all about working with the community to set up the groups and activities that people want and then encouraging people to get involved, run them and develop them further. In this way it is hoped that people gain skills and confidence, and develop new interests and a sense of well-being. Critically, in times of serious financial constraints, people can be supported to move on and through traditional social services. Intensive support for shorter periods is one way to do this, as is ensuring that local, community-based options are in place. The Project comprises three linked experiments; Time Banking, collaborative service provision and a Direct Payments pooled budget trial. The Time Together Initiative (Time Banking) Central to the Gorseinon Project is the Time Together initiative. This gives a strong community development flavour and drive to the project. It has an established methodology that we are using to get things going fairly quickly and it unites providers and citizens in a way which forces us all to think and do things differently. All the other elements of the project will feed into and benefit from the momentum created by Time Together.

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As explained in the last newsletter, The Time Together (Time Banking) initiative is setting up two bodies:

The Time Together Alliance: a group of service providers working or with an interest in the Gorseinon area. These providers meet to inform each other about what they offer to the people of Gorseinon. Members include statutory sector social and health care providers, Council services such as leisure and community centres, voluntary sector employers and groups and wider non-service sector employers--any organisation, in fact, with a stake in Gorseinon that wants to get involved. These organisations will share information about their services so that everyone knows who does what. The Time Together Network: a group made up of any citizen of Gorseinon who is interested in finding out what is going on in their area, and sharing any skills, knowledge or interest they have with others. The group is open to all citizens of Gorseinon, and so there will inevitably be some people who are also users of Social Services.

The idea is that the Network (the people) share their skills and interests with others on a voluntary basis and as a reward for their efforts gain ‘credits’ that they can then use to get ‘free’ use of the services offered by the Alliance. 45 year old Joe used to be a painter and decorator but has been out of work for the past 5 years. He is bored and gets depressed at the prospect of never working again. His GP (a member of the Time Together Alliance) suggests that he goes along to a meeting of the Time Together Network. Once there he lists his interests and skills and discovers that there is an embroidery group who meet in a dilapidated room attached to the local Chapel who would like their space redecorated. Joe offers to decorate the room for the Group. In exchange for this voluntary help, Joe earns some Time Banking credits which he can ‘spend’ in any of the participating Alliance organisations. Joe chooses to use these to try out a running training session at the local gym. In a few months Joe is meeting other runners, is getting fit training for the London Marathon, and has developed a much more positive outlook on life. In addition, through his voluntary efforts his skills as a painter and decorator have been noticed and he has been approached by a local decorator who wants to take him on.

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This fictional example illustrates the possibilities for Time Banking. Instead of people being viewed as a series of ‘needs’ or ‘deficits’ they are asked to list their interests and think about what skills they have to offer. These skills might range from knowledge of foreign languages, or how to use a computer or sewing machine, to being able to chat easily to people, make people feel welcome, or being good at remembering things. By matching people up with each other so that they share skills in a reciprocal way — ‘you help me with this, and I will teach you that’ — everyone benefits. The whole idea is that people begin to recognise that they are not just passive recipients of services, but are valuable members of their communities. They have the power to give things back and build active communities. They share responsibility for making the place they live vibrant and inclusive. A Collaborative Approach to Service Provision Social care providers based in, or working with people who live in, the Gorseinon area, are working together to map the resources they have so that it might be possible to use them more effectively to meet the needs of people across traditional adult services boundaries. Providers will work collaboratively in order to support service users to achieve their outcomes in the most effective and efficient way. Ann is 55 and has a visual impairment. She has lost a lot of confidence as her sight has deteriorated and is now isolated and lonely. In discussion with her Social Worker she has said that she would like to feel that she has a purpose in life, and that there is something to look forward to again. Together they devise a 3 stage action plan for achieving Ann’s outcomes. Firstly, the Social Worker refers Ann to the Rehabilitation Service at Swansea Vale Resource Centre, which supports Ann on a mobility training programme. The next step is for Ann to get to know what’s going on in her home area. The Rehab Officer contacts provider colleagues in the Gorseinon area to see what is going on locally that might be of use and interest to Ann. They discover that there is a women’s group meeting in the Mental Health Day Centre in Gorseinon. This Group organises discussions, shopping trips and lunch dates and Ann is interested in going along. Within a few weeks Ann is gaining in confidence and, independently of the Day Centre, has decided to go along to a Time Together Network meeting to see what else she can do and if there is any way she can share her new-found confidence to help other visually impaired people. When the Social Worker reviews the action plan, Ann no longer requires the service at the Day Centre and has joined the Time Together Network where she has become a real asset to the local support group for people with visual impairments.

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Direct Payments Pooled Budgets Trial There have been various examples in the UK of Direct Payments’ users pooling their budgets. In many cases this has resulted in them being able to get more for their money. (Whereas a day centre place would usually be provided for 8 hours, the Direct Payment to replace it may only pay for a PA to work on a one to one basis for 4 – 5 hours. By pooling budgets with others with similar interests, more time can be afforded, since in most cases one-to-one support is not required for the whole period.) Just as important as getting more for the money, by pooling budgets people have been enabled to meet others (counteracting the loneliness that could result from getting an individual service) and have benefited from sharing ideas and becoming involved in more interesting and imaginative activities in their communities. Some Direct Payment users have put their budgets together to create their own pool of workers making it easier for individuals to find the right PA and also access replacements when their PA is ill and unable to work. Working in a specific locality provides an opportunity to try out the use of pooled Direct Payments for interested Gorseinon residents to see if this might be a useful approach to develop further in Swansea. In Conwy various client groups have pooled their Direct Payments to form "Circles of friends" and short break groups, thus increasing the hours available to them, the types of activities accessed and their social contacts. In Conwy Children’s’ Services, families have pooled the budgets allocated for short breaks and have used them to provide regular sleepovers at each others homes, ensuring the children have the same form of social activity as their peers. In Slough a group of Asian adults with Mental Health problems have pooled their otherwise small DP budgets so that they can afford more diverse activities and enjoy time together. They have visited an Asian Lifestyle Event, the London Eye and been to Bournemouth. “One of our members is 24, but he’d never seen the sea before we went to Bournemouth”. As a result, the DP users are gaining confidence and a new outlook on life, so much so that one member has recently secured a job. In this case the pooling of budgets has allowed users to engage in activities which are valued and meaningful to those from BME communities. There are other examples of how pooled budgets have been used in the next article.

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On July 15th this year an information event on the Gorseinon Project was held for Social Workers from across Adults Services. Many felt that the project heralded a return to traditional social work values and the idea of community social work, where co-operation and ‘mutuality’ were encouraged. Whilst some felt that the sense of community had disappeared in many areas, all agreed that an experiment to see if it could be recreated for the 21st century was an interesting idea. On September 1st the first group of citizens were invited to a meeting to sign up for Time Together and to find out more about pooling their Direct Payments. In the next 8 weeks another hundred people will be invited to join. The next article gives you a bit more information about this event. We will be updating you with more information about our progress in the coming months, but in the meantime if you have any queries or suggestions about the Project, please contact Jane Tonks on 636645, [email protected] or Mariann Hewitt on 636693, [email protected] .

Individual success is not just about individuals. Dame Tanni Grey Thompson

The person who has no imagination has no wings. Muhammad Ali

Nothing great was ever achieved without enthusiasm. Ralph Waldo Emerson

What you leave behind … is what is woven into the lives of others. Pericles


Direct Payment Users Event in Gorseinon All Direct Payment clients living in the Gorseinon and surrounding area were invited to a tea/coffee and cake morning on 1st September. The aim was to give them an opportunity to get to know each other and perhaps explore the possibility of pooling their Direct Payments together so they can get more out of their money. Nine clients came along, most of them with carers or PAs as support, many of whom were also from the Gorseinon area too. We hope that Direct Payment users can play an important part in the Time Together Project currently being developed in the Gorseinon area, and also see some real benefits. One way this has been done in other parts of the country is through something called ‘pooled budgets’. Put simply, this means that several people put their Direct Payment money together – with the help of Social Services – in order to fund something that benefits them all as a group. This has worked successfully in Ceredigion where Direct Payments were pooled to enable a small group of disabled children to access community sports and leisure activities and employ qualified sports coaches to improve their skills. In the same area parents of autistic children have set up a support group and pool their Direct Payments to provide appropriate care for their children while they meet. Those attending also found out more about time banking and the opportunities it might offer for individuals to get more involved with their local community. (There is more about this community initiative in the previous article.) Everyone got the chance to meet and talk to each other, and hopefully they all came away with some fresh ideas on what they could achieve with a pooled budget but also how to get involved and utilize Timebanking. The morning also included a tour of the Centre, and more information about the Gorseinon Development Trust. Everyone who attended, carers and PAs included, also got to meet many of those who sit on the Gorseinon Project Steering Group as most of the group was present on the day. If you would like to know more about this element of the Time Together Project, or are working with a service user who might like to get involved, please contact Mariann Hewitt on 636693, [email protected]


Resource Allocation Workshop

A major feature of Citizen Directed Support has been the drive to develop greater transparency about the link between a person’s eligible needs and the resources that will be available to meet those needs. This has been interpreted and taken forward in several ways, for instance through the allocation of personal budgets which are a clear upfront allocation of money to citizens to purchase their own support, or as a method to determine an indicative budget to assist in the development and implementation of a support plan. In Swansea, we are exploring how we might use a resource allocation system (RAS) or a similar tool to support the fair and consistent allocation of resources. This would be used after a Community Care Assessment (UA) has been completed following a period of re-ablement or when a person’s needs are recognised as being stable. The outcome of a RAS would then inform how a support plan would be put into action. Work recently got underway with a RAS workshop held in mid-August to examine how we tackle these issues locally. The day workshop was divided into morning and afternoon sessions and essentially each session tackled the two main priorities: to develop a RAS calculation system for Swansea Social Services and to look at how our self-directed assessment questionnaire may appear. A summary of the day’s events is given below. Morning: Developing a RAS for Swansea Who attended? Planning, Information, Finance, Training and Contracting Officers, a Team Leader and the PO for Disability Services (Chair). What was discussed? It was felt necessary to clarify a number of issues before any RAS methodology could be trialled in Swansea. For example, what would constitute a service user in the trial? What services would we include and exclude? Would we look at commissioned costs or delivered costs? What would be a suitable sample size for the RAS to give confidence in the methods behind it? The first part of the morning was spent discussing these themes.

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What was decided? A number of decisions were made to clarify the points above i.e. a ‘service user’ will include those accessing community meals and the RAS will be based on delivered costs rather than commissioned costs. It was then decided that a pilot study will be employed to test out our RAS calculation method. A relatively small sample of adult service users will be selected at random yielding a 90 per cent confidence level in the results. If the RAS calculations appear accurate for these service users, a larger sample will be drawn producing a confidence interval of 95 per cent. Afternoon: Developing a self-direct assessment questionnaire for Swansea Who attended? Planning, Information, Training and Contracting Officers, Practitioners from across Adult Services and the PO for Disability Services (Chair). What was discussed? The group was split into three smaller groups and each group asked to critically appraise a number of self-directed assessment questionnaires from local authorities who had already developed their own tool. This was very much a practitioner-led discussion: social workers debated – with their own service area in mind – the ease, clarity, appropriateness and order of questions within the different examples. In particular, social workers discussed how well their service users may be able to complete the example forms with limited assistance, the point of any self-directed assessment. What was decided? The groups came together and decided that, of all the self-assessment questionnaires evaluated, the version developed by West Sussex Council was the most favourable. It was the most person-centred, clearest, used non-patronising language and, unlike some other examples, followed a logical order of questions for the service user. Next steps… Overall, how will this work develop? Clearly there is much to be done: developing budgets for service users and the methods behind those budget calculations are crucially important. Initial work will be undertaken by the Performance and Information Team to identify a sample of service users on which RAS methods can be trialled. POs will also be asked to identify individual staff members who can support this work stream. Updates on the RAS work will be provided via the newsletter and bulletin.


Carewatch Amanda Lince, the new Operations Manager for Carewatch in Swansea, has written to tell us about some of the ideas the company is developing to enable them to provide a more person-centred service. Carewatch is a national company with a large number of regional offices which provides a range of domiciliary care services. With the personalisation agenda being further advanced in England than it is in Wales, Carewatch nationally has begun to look at how to develop its approach to provide a more person-centred service. Cluster working The approach now being piloted in a number of areas in England is cluster working. This means that rather than an individual care worker supporting a number of service users, small teams of care workers provide care and support services to a cluster of service users living in the same geographical area. Where possible service users and carers will be matched so that they have some shared social or cultural interests, and any serious incompatibilities avoided. Service users and their carers are made aware of all staff who may be supporting them, including emergency arrangements. Some advantages of this approach are:

• Small, integrated staff teams with a single supervisor work together closely to support each other. Where possible staff work in their local area.

• Staff gain a more detailed knowledge of community services within

the cluster area, such as GP services, schools and colleges, places of worship and leisure facilities. This creates an atmosphere of familiarity and trust which can foster effective multi-agency working. Staff can also share this local knowledge with carers.

• Regular forums and feedback offer carers the opportunity to share

their views and have a say in the running of their local service, which may require different methods of delivery than the same service provided by Carewatch only a few miles away.

• Additional activities that service users might welcome, such as trips

and home hairdressing, can be effectively planned and coordinated within the cluster. There can also be cluster procurement discounts for local products and services.


• Staff absence (planned and unplanned) is covered by care/support workers who understand the service user’s individual needs and may already have worked with them.

Banking hours Another aspect of cluster working is the opportunity that it gives for service users to bank care hours. To ensure an efficient use of commissioned hours, Carewatch are developing a banking system where unused hours can be stored for the individual client or group in which the client belongs. The banked hours can be used when the service user needs them or another service user within the group needs extra care hours. These hours can be used for specialist intervention, to help deal with crises as well as help at one-off events in peoples’ lives. Banked hours can also be used for community-based activities that support the service users’ wellbeing and with unused hours banked on behalf of the cluster as a whole, people may be able to access extra support. For example, two care workers might be able to take four service users to bingo, thus halving the number of hours that would have to be banked by each individual. In Peterborough Carewatch has a service user who banks two hours per week until the last week of the month and then uses them to go fishing with the member of staff who shares this interest with him. The agency values the system as it allows them flexibility in dealing with the individual’s needs while simultaneously allowing them to highlight where services are succeeding or where more focus is required. How well is it working? It has become clear that successful cluster working requires a shared vision and clarity about roles. It works better in denser urban areas than in more geographically spread-out rural areas. Carewatch has found banking hours to be more successful in some areas than others. For instance, within Supporting people services and floating support, banked hours have been used very effectively. The system has also worked well in learning disability and mental health services. However, in generic domiciliary care for elderly, they find that a philosophy which is task based rather than outcomes based does not allow for the banking system. Care plans which were more outcome-focused could provide scope to develop this, though there will always be older service users who want and/or need a traditional domiciliary care service.


Will it happen in Swansea? This approach to providing care and support is still very much at an experimental stage, even in England. In Swansea no pilots have yet taken place. Before this happened there would be a need for more information about what had worked well, and less well, in other areas. Locally this would need to be supported by better knowledge of what service users and carers would like from their service, as well as closer working between commissioners, care managers and providers. For more information, contact Amanda Lince at Carewatch on 01792 457766.


Age Concern Swansea (Supporting People Service) – A Client’s Journey Age Concern Swansea are currently looking at developing outcome-based person-centred services, in particular, Independent Advocacy and Befriending Services. They have sent us an outcome-based case study from their Supporting People Service – "A Client’s Journey” - that explains the different ways they have supported one particular client to feel safer at home and less socially isolated. Mrs X is 76 years old and she lives alone in social housing, she has no family or friends around and about. She has suffered from poor physical health for some time and is visually impaired. The Referral We were asked to work with this client to reduce her social isolation in 2008. Her Support Plan and the Outcome Achieved. We visited Mrs X to complete a full assessment of her needs and agreed her support plan with her. This included the following activities:-

1. A weekly befriending service to enable Mrs X to engage in social activities in her local community, resulting in increased self-confidence.

2. Support to enable her to access the local day centre through Swansea Social Services resulting in increased social interaction and an increased circle of friends.

3. Support to access a further assessment by the local Sensory Impairment team which led on to the provision of aids and adaptations through Social Services and our own Home Services, resulting in Mrs X feeling safer in her own home and reducing the risk of falls and accidents.

4. Support to access an appropriate refuse and cleaning service, resulting in an improved living environment for the client and a reduction in the risk of falling and infection.

5. Support to access British Gas to manage an ongoing issue regarding the client’s current heating system resulting in a reduced risk of accidents and improved cost effectiveness.

6. Support to discuss issues with the housing officer with regard to local neighbourhood disturbances resulting in the client feeling safer in her own home.

7. Support to purchase a new cooker through a local grant programme resulting in an improved ability to manage her nutritional needs.

Future Work We will continue to work with Mrs X to reduce her social isolation by widening her social networks and hope in future to be able to reduce our service to her as her confidence grows and we open up other avenues to her through our partner organisations.


Change of Date – Personalisation Event In the August Bulletin we mentioned that a Personalisation Event for an invited audience of citizens would take place on 4th October. Since then the organisers have met again with the Citizens Reference Group to plan the event, and it has become clear that the sort of event that everyone would like to put on, with a considerable degree of citizen involvement, could not be achieved within the timescale. Everyone was in agreement that it would be better to postpone the event until later in the year. The new date for the Citizen’s Event is 6th December 2010.

Person-Centred Thinking “If people who use services are to have positive control over their lives, if they are to have self-directed lives within their own communities then those who are around the person, especially those who do the day to day work, need to have person-centred thinking skills” (Helen Sanderson Associates). Some staff will already be familiar with person centred thinking and the tools used in person-centred planning while others will not yet have had the opportunity to attend training. Person-centred thinking skills are not only fundamental for citizen directed support, they also underpin good practice for staff working in a variety of settings. The first training course in Person-Centred Thinking will be run in early October, with two further courses taking place in December and January. A high number of applications have already been received. Those who don’t get places on the initial three courses will be able to apply again after January, when a rolling programme of training will be available.

We hope to bring you more information on the course content in the November newsletter. In the meantime, if you’d like more information on person-centred thinking and Helen Sanderson Associates, who will be delivering the initial ‘training for trainers’ courses, please go to www.helensandersonassociates.co.uk.

Today's problems cannot be solved if we still think the way we thought when we created them. Albert Einstein

"Transformation doesn't take place with a vacuum; instead, it occurs when we are indirectly and directly connected to all those around us." Byron Pulsifer


Norton Lodge Information Centre Over 100 visitors attended the launch of the new Information Centre at Norton Lodge Day Centre in Mumbles on 26th August. The Centre specialises in information and advice for the over 50s, though any adult living in the local area can use it. The focus will be health and well-being in its broadest sense, covering health and social care, finance and benefits, home safety and community events and activities. The Centre will contribute to our aim of giving citizens more control over how their needs are met, since good information and effective signposting helps people to know about and get support that is right for them at the right time. Although there are a number of organisations in the city centre that offer advice to older people, until now there has been no equivalent in the west of the city. The Centre is located in Norton Lodge’s Conservatory and will be open each weekday between 10.00 am and 4.00 pm. There is no need to make an appointment – just drop in. Visitors to the centre will be able to pick up leaflets on a range of subjects, and can also use computers to check out information on-line. Staff will be on hand to offer advice and signposting. Starting this autumn, there will be a specialist surgery each Thursday where professionals from a range of organisations will visit to offer advice and assistance. We hope to be able to post a list of forthcoming sessions on the Council website. Social work staff are welcome to use the Centre, and to offer suggestions for how it might develop. For more information contact Debra Hobby or Sheila Thomas on 403465.

In everyone's life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit. Albert Schweitzer.

“The greatest good you can do for another is not just to share your riches but to reveal to him his own.” Benjamin Disraeli

citzen directed support - september 2010

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