introducing beyond limits
DESCRIPTION
Sam Sly explains how Beyond Limits will be working to bring people back home from institutional services.TRANSCRIPT
Sam Sly
Beyond Limits (Plymouth)
Social Worker for people with learning disabilities and mental health needs
CSCI (CQC) Change Team Cornwall (changing housing
and support that had gone badly wrong) Cornwall PCT continued to improve quality Bournemouth Campus re-provision United Response improving quality Developed ‘Hands Off Its My Home – a path
to Citizenship’ Director for Beyond Limits with Doreen
Kelly Columnist for Learning Disability Today
3 year project with NHS Plymouth Personalising Commissioning
Using Individual Service Funds Using Service Design & Working Policy 20 people currently in Hospital placements 20 people with big reputations 20 people who will get a tailor made service 20 people who will get a life that makes
sense to them
Not a flexible enough provider market Good planning doesn’t happen People are not listened to and understood We don’t share risk (professionals, person,
family and provider) We (professionals) think we know best Its an easy option Systems for commissioning support are too
rigid and look at short term savings
‘People often end up in expensive out of area placements because local systems have not the flexibility to develop suitable personalised responses. This leads to people being over-supported and cut off from their own communities. There are currently 10,000 people with mental health problems supported in out of area placements and research suggests at least 5,000 of these are without significant clinical justification. The use of individual budgets as part of intentional programme to bring people back to their own communities with personalised support could save £100 million a year.
Vidhya Alkeson & Simon Duffy ‘Health Efficiencies - the possible impact of personalisation in Healthcare ‘ 2011
Good planning (we usually know who is at risk from childhood)
Services tailor-made for the person People given Budgets, power and control Providers treated as partners and not held at
arms-length Intuitive Commissioning Community connection and contribution seen
as a must Working in partnership with families
Individualised, local solutions providing good quality of life not those too large to provide individualised support, too far from their homes, and providing good quality of life in the home and as part of the local community.
Direct payments and individual budgets should always be considered and be more widely available.
Closer co-ordination between the commissioners paying for services, the managers providing services and the professional specialist advising on the support people need to ensure advice is both practicable and acted on.
Commissioners should allocate a budget to be used to fund a much wider variety of interventions as an alternative to placement in a special unit.
Jim Mansell ‘Services for people with learning disabilities and challenging behaviour or mental health needs’ 2007
All have been abused Have moved between 6-25 Institutions Youngest 26 Oldest 56 First admission to an Institution aged 14-22 All on MHA Section for between 5-14 years Most have moved to more and more secure
accommodation as they have fought the system All families have felt loss of control, marginalised
and physically unable to stay in touch All people have the same hopes and dreams as all
of us
Service Design (Partners for Inclusion/Beyond Limits)
‘Every service is designed, from scratch, with only the person in mind, and modified in the light of experience and as things change. Individual service design in rooted in the organisation’s commitment to help everyone achieve citizenship for themselves’.
Personalised Support – Julia Fitzpatrick (2010) Published by the Centre for Welfare Reform
A good facilitatorThe personFamily and significant people in their lifePeople who know and care about the personPeople with strong relationship with person
Planning and pre-move transition is funded (one off payment clawed back through reductions from years 2 onward)
Post move transition is funded
On-going budget flexible in first year
Greatest reductions after year two and three
Take time getting to know person and significant others
In a comfortable environment Telling their story Being in control Direction Money Home Support Contribution (Giving something back)
What does the person do with their time now (routines)?
What should we keep doing?
What should stop happening?
What should they start doing?
What should we start doing?
What hours of paid support do they need? What will happen in those hours? What support could help the person become
more independent or develop more natural support?
What do we need to do to keep them and others safe?
(safety mapping and enabling is a natural by-product of service design)
Who worked well in the past and who didn’t and why?
What kind of person – quiet, busy and lively?
What knowledge, skills and experience?
What contracts are needed?
Leadership skills needed?
What hobbies interests should they have?
Man or woman? Age?
Being seen as a fellow citizen by others Controlled by the person Provided by who you choose Enables you to do what you want and does
not control what you do Invisible Simon Duffy (2006)
It enhances the person’s dignity and respect in the community
It helps the person be present in the community
It helps the person participate in community life
It helps the person develop and learn new skills
It gives the person choice and control
Many great plans are made and fall down because they are not followed up by a detailed ‘how to’ bit.
It is fundamentally important that once a service is designed a ‘how to’ plan is written. Partners for Inclusion and Beyond Limits call this a Working Policy.
Involves the person (if they wish), present and past professionals and family
Aged 28 25 different placements furthest was 349
miles away from home Went through Criminal Justice System Sectioned for 6 years Physical Intervention from aged 17 Family seen as a problem She was seen as a big problem Always wanted to come home to be part of
family
Part of the family (highs and lows!) Has own home Interviews for her team Health problems stable Been to Bristol/Cardiff to visit friends twice Tickets for Peter Andre! Ice skating lessons Been Clubbing loads (first times in 11 years!) Says she never wants to go back to Hospital
Hospital doesn’t work long or medium term
Being away from family and community is destructive
Planning for a normal life has to start from day one of admission
Matching teams makes the difference
Individual flexible budgets
Cultural change is required
People want lives
Hospitals Hostels and
Campuses Residential Care
Homes Don’t let
‘supported living’ be the next institutions
People want to live in their own homes just like you and me
