Safeguarding in the Era of the

Personalisation Agenda Jill Manthorpe

Social Care Workforce Research Unit

King’s College London

(also Senior Investigator NIHR and NIHR School for Social Care Research)

On behalf of the IBSEN team: Caroline Glendinning, David Challis, José-Luis Fernández, Sally Jacobs, Karen Jones, Martin Knapp, Nicola

Moran, Ann Netten, Martin Stevens, Mark Wilberforce

Norwich MRC– 1 June 2009

1 Policy and practice background

Individual budgets (IBs)

Central to the government’s ambition to ‘modernise’ social care …

… at the heart of the ‘personalisation’ agenda …

… to promote choice

2005 – Cabinet Office Strategy Unit report; and Social Care Green Paper

Build on experiences with: Direct payments

In Control

July 2005 – invitation to English LAs to be pilots

Evaluated by a team from PSSRU (LSE, Kent, Manchester), SPRU (York) and SCWRU (KCL)

safeguarding

No secrets – its strengths and limits

Growing but piecemeal changes

POVA List - ISA

Sexual Offences Act – MCA + offences

Human Rights Act

Move from protection to safeguarding

No secrets review

2Individual budgets: the pilot programme

Principles underlying IBs

Greater role for service users in assessment of their needs.

Individuals should know the resources available to them before planning how to meet their support needs. Recommended using a RAS

Integrate resources from several funding streams into an IB.

Simplify and integrate/align multiple assessment processes and eligibility criteria. (But adult social care the gateway to an IB)

Encourage IB holders to identify the outcomes they wish to achieve and the ways to achieve them.

Support individuals as they plan how to use IBs – including information on costs and service availability

Try different options for deploying IBs (ways of managing and using the money).

Deployment options

Considerable local and individual flexibility

Cash direct payment

Care manager-held ‘virtual budget’

Service provider-held ‘individual service account’

Third-party individuals and trusts

Hypothesised benefits of IBs … Increasingly streamlined assessment processes would be set up across

all relevant agencies

Resources would be allocated transparently

Variety of funding streams involved

Wider choice of options for spending to give flexibility …

… and more control over resources so people can access them

Greater personal freedom and independence

Less pressure on the family

Self-esteem and sense of identity would be greater

Quality of life would be improved …

… cost-effectively

Proportionate arrangements for accountability, striking balance between safeguarding and independence

3Evaluation: design, methods

IBSEN evaluation questions

CORE QUESTION Do individual budgets offer a better way to support disabled adults and older people than conventional methods of resource allocation and service delivery?

If so, which models work best and for whom?

User experience

Carer impact

Workforce

Care management

Provider impact

Risk & protection

Commissioning

Outcomes

Costs

Cost-effectiveness

Evaluation dimensions

But where was safeguarding?

We found no real evidence from Direct Payments about safeguarding but many experiences

We found little links with Adult Safeguarding in the pilot sites

We found concerns about duty of care, reviewing, risk – typically around CRBs

4Results (a selection)

Assessments

FACS remained in place

Growing use of self-assessment and outcomes focus

More integration of information from other agencies

Allocating resources Most sites (not all) developed RAS:

Itemised domains where help needed

Amount of help scored

Translated into sum of money for budget

RAS and other assessment information often subject to Panel approval

Staff concerns:

sensitivity and validity

inappropriate incentives (‘points mean pounds’)

Support planning

Compared with conventional care planning: Care managers spent more time helping plan IBs Care managers expressed more satisfaction with user

relationship

More roles for users and carers in planning support

Limited use of external specialist support planning/brokerage agencies

Care managers’ anxieties: Boundaries and legitimate use of social care resources

Quality of services – inappropriate/unproductive use

Burden of managing IBs – hiring and firing (un)suitable workers

Risks of physical/financial abuse

Loss of collective ‘voice’

Patterns of IB expenditure

IB as direct payments

IB as care- managed budget

% Mean annual expenditure

% Mean annual expenditure

Personal assistant 64 £8,940 47 £7,420

Home care 20 £7,140 40 £7,480

Leisure activities 43 £2,020 24 £1,750

Planned short breaks

24 £1,750 15 £5,460

Other 23 £930 21 £270

Innovative uses of IBs

Accommodation Employment and occupation Health-related

Cleaning service Going out: trips/cinema etc. Private health care

Decorating service Classes/arts and crafts Massage for carer

Gardening service Gym membership/swimming Alternative therapy

Computer maintenance

Admission fees for service user and PA

What about LA safeguarding role?

Lead agency

Addressing great expectations

Managing when things go wrong

A residual duty for residual social workers?

Loss of experience in workforce?

Addressing issues of de-commissioning

The place of safeguarding risks in the RAS

5Issues for practice and policy

IB pilots – unfinished business? Extended transition/transformation

Resources tied up in services, double funding ?

Limited follow-up – different ‘steady state’ outcomes?

Impact of uncertain ‘pilot’ status:Risk aversion?Reliance on conventional deployment mechanisms

Inhibited changes in staff culture

Developing RAS – got it right?

Shaping the market

Practice issues

Managing change

Managing risk – how ?

Shaping the market

New ways of deploying Personal Budgets

Saying no or not yet – closing PB option

What does review and monitoring mean?

Issues for policy Resource allocation – underlying principles

Funding streams – personal budgets (social care only) or individual budgets?

Relationships between social care PBs, NHS resources and NHS personalisation pilots

PBs, FACS and charging policies – need for debate on resource allocation

The legitimate ‘boundaries’ of adult social care and uses to which funds can be put

Concept mapping

A personalised social care system will look like …

My job as a social worker in a transformed social care system will be…

My experiences of Direct Payments lead me to conclude…

My fears for some services users if they take up personal budgets are…

My understanding of the processes of transformation of social care will improve if…