Doncaster's Story

From seeds of ideas to

redesigning processes

Changing the Personal Budgets process – why?

• A review following initial implementation identified improvement areas

• The developing policy agenda encourages it (Think Local Act Personal-TLAP)

• Service User and staff feedback identifies issues with the current process

•Work undertaken prior to Care Act and guidance implementation

Introducing the Re-Script Group

• Core Group Members:• Social Workers • Team Managers• Specialist Services• Business Improvement

Key Aims of the Group

• Assessment Paperwork and Processes:• Leaner• Supports social workers in recording their

professional assessments• Aligned to an asset based and outcome focussed

approach to assessment• Captures the ‘conversation’, the Service User’s ‘story’

and their aspirations

Creative Conversations exploring Asset Based Social Work

Dr Celia Harbottle

http://www.celiaharbottle.co.uk

Creative Conversation Aims

• To enable social workers to examine the evidence base and current policy context indicating a need for a cultural shift in social care provision underpinned by a re-defining of the social work role.

• Explore the need for change and what is meant by asset based social work, reflecting on pre-existing skills – under used in traditional care management approaches

• Facilitate social care workers to have had the opportunity to explore the need for a culture shift in social work whilst recognising that they have the core skills to make it successfully.

• To consider the wider evidence base for asset based social work and will be able to see its place in DMBC’s way of working

Our Journey

• Project Team established

•Work undertaken with staff, services users

and advocacy agency

• Other Local Authorities documentation

considered

• Decision for bespoke development

Key Aims Further Developed

•New Assessment and Process no longer in line with existing

RAS

•Resource Allocation System (RAS)• Driven by professional judgement of the Social Care Worker• Non-complex, transparent and a total shift away from ‘tick boxes’

• Approach to Development Work:• Operational input throughout all development work

• From research to initial idea to prototyping to testing • Ensure robust and fit for purpose at operational level

• Co-opt in additional expertise when required• E.g. Finance, RAS Expert, OLM Consultancy

Our continued journey

• Prototyping and phased approach• Specify RAS model• Desktop sampling of 450 current random cases -

statistically significant figure to give 90% accuracy • Analyse, review and modify sampling results• Make changes to model and calibrate• Develop supporting tools• Live test phase – 200 random cases• Final calibration

New Assessment Form

• Current Form• Manual form 30 pages –

too long to complete• ‘Deficit’ based. Not

aligned to Asset Based and Outcome Focussed approach

• Doesn’t capture the Person’s ‘story’

• Fixed tick box format due to driving the RAS

• New Form• Lean: 10 pages, some pre-

populated via CareFirst• Aligned to Asset Based

and Outcome Focussed approach

• Captures the Person’s ‘story’ and aspirations

• Free flowing, does not drive the RAS – no tick boxes

A Look Inside The New Form

1) A day in my life ……….

Describe a typical day of your life from when you wake up. Think about the things you do every day and whether you do them by yourself or with help and support. For example think about how you:

look after yourself and those you care for (e.g. a child, parent or partner) manage any health conditions or disabilities and manage your medication move around your home (both inside and outside)

The things I tend to do every day from when I wake up ……..

(Example: I wake up at 7am… I have a drink of water that has been left by my bed by my daughter the night before. I start to think about getting up and ready for the day…. I get out of bed.)…

A Look Inside The New Form

1) A typical week of my life ……….

Describe your typical week and the things you tend to do on different days. Also tell us about any days where you do not get the help and support that you told us about for question 5.

My typical week ….

Monday …..

(Example: I go to a Luncheon Club with my friends the first Monday of each month. My granddaughter visits me in the afternoon and does the ironing.)

Tuesday …..

Wednesday …..

(Example: This is the only day my daughter cannot come to get me ready for the day due to family commitments.)

A Look Inside The New Form

1) Who is Important to Me?

This part of the form is about who is important to you and who helps to support you. For example: Family members or friends Neighbours or people from your local community (e.g. members of local clubs,

voluntary organisations or places of worship) Professionals (e.g. doctors, community nurses, counsellors or support workers) Paid supporters or helpers (e.g. cleaners or gardeners)

Who is important to me?

Their role or relationship to me

Why they are important to me / how they help to support me

Example: Fred Bloggs

Friend

Visits me each week and helps me to do the shopping.

A Look Inside The New Form

1) What’s Important to Me? Think about the things that are important to you and you want to do but can’t. What’s stopping you from doing these things?

My wish list of the things I would like to do but can’t ….

What’s stopping me from doing the things on my wish list? ? …..

Example: Go to my local place of worship on a Sunday.

Example: I have no transport.

New Resource Allocation System

• Current RAS• A shift away from

professional judgement • Tick boxes and spread

sheet drives complex and hidden calculations

• Inaccurate – uplifts and cases going to panel

• Bureaucratic and inefficient – delays payment to Service Users

• New RAS• Professional judgement

determines the budget• Transparent with no hidden

or complex algorithms or calculations

• More accurate – uplifts and panel on exception basis

• Lean and efficient enabling quicker payment to Service Users

A Look At The New RAS 1-2

need areas

3-4 need areas

5-6 needs areas

7-8 needs areas

9-10 needs areas

11-12 needs areas

Low risk if outcomes are not achieved (1-7 on Risk Matrix)

A B C D E F

Medium level risk if outcomes are not achieved (8-14 on Risk Matrix)

G H I J K L

High risks if outcomes are not achieved (15-21 on Risk Matrix)

M N O P Q R

Very high risks if outcomes are not achieved (22-28 on Risk Matrix)

S T U V W X

A Look At The New RAS • Professional judgement driven

• 3 key professional judgements:• Number of eligible unmet needs that remain outstanding

(not met via Circle of Support, community or universal services etc)

• Risk Severity (level 1 to 4)• Risk Likelihood (level 1 to 7)

• Multiply Risk Severity level by Risk Likelihood level to get an overall risk score to determine overall risk.

• Number of needs and overall risk score determines the cell on the RAS Grid (A to X)• (Budget amounts available once development work is

complete).

A Look At The New RAS

• Risk Severity• Four levels:

• 1: Restricted independence• 2: Moderate threats to independence• 3: Serious threat to Independence• 4: Immediate risk of harm/neglect/crisis

• Definitions and guidance information in packs – broad guidance not definitive.

• Aimed at informing judgements and enabling consistency.

A Look At The New RAS • Risk Likelihood• Seven Levels

• 1: Occasional incidents• 2: An incident every month• 3: Some incidents a month• 4: An incident a week• 5: Several incidents a week• 6: An incident a day• 7: Several incidents a day

• Definitions and guidance information in packs – broad guidance not definitive.

• Aimed at informing judgements and enabling consistency.

Support Planning

• Current • Duplicate recording• Deficits based & service led• Prescriptive: ‘dictates’ how

budget will be spent• Budget sign-off after

itemised break down• Informal support not always

captured• Bureaucratic - tying needs to

points to budget• Delays payment of budget

• New• Pull through of info on CF• Evidence based practice• Shift to outcomes focus• Flexibility of spend – DP policy• Higher level, not pinned down

to itemised break down of spend• Budget sign-off for agreed

outcomes not services• Incorporates informal care &

community resources• Leaner, person centred and

Care Act compliant

Reviews

• Current• Review = Re-SSAQ & Re-

RAS for all cases• Duplicate recording –

manual paperwork & record on CF• Fixed timeframe for all

reviews• Deficits and services focus• Uplifts and panel

• New• Record once in one place –

pull through of information• Proportionate: Re-assess &

re-RAS only if change • Budget: sufficiency principle • Creative conversations and

asset based approach• Evidence based practise• From service led to outcomes• Individualised timeframe for

reviews • Less cases to panel and via

CareFirst

Carers

• Current• Manual - part 2 and part 4• Prescriptive - tick boxes • Recorded against service

user record on CF• Impacts service user RAS £• Equipment / items led• Bureaucratic process for

flexible support fund release

• Not Care Act compliant

• New• One assessment form • Free flowing, no tick boxes• Mirrors service user process

and concept• New carer RAS – detached

from service user RAS• Flexible spend - outcomes • Budget: sufficiency principle• Manager authorises budget• Care Act compliant –

eligibility criteria, entitlement in own right

Risk Severity Threat to Carers Well-being 1 – 2 Needs

3 – 4 Needs

5 – 6 Needs

Moderate threat to wellbeing M1 M2 M3

Serious threat to wellbeing S1 S2 S3

Immediate risk of crisis / carer breakdown I1 I2 I3

Carers RAS Grid

• Replaces Flexible Support Fund• One off DP to carer – flexibility and outcomes focussed• Carer starter RAS amounts will replace numbers in grid• Financial modelling will determine RAS £ and grid size• Definitions and guidance information will be available –

broad guidance not definitive

Next Steps ……

• Care Act training and resources

• CareFirst training

• Go live April 2015

• Re-Script Group widened to support roll out & teams post go live

• Post implementation review

• Back Office Processes

• RAS recalibrations on a regular basis •

Re-Script: ‘piecing’ it all together

• Creative conversations – Dr Celia Harbottle

• Shift from deficits and services

• Shift to assets, strengths and outcomes

• New RAS driven by professional judgement

• Budget available to spend earlier

• Care Act changes including new eligibility and Carers

• Compliance with the Care Act

AnyQuestions?