Safeguarding in the Era of the Personalisation Agenda

1. Norwich MRC– 1 June 2009 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

2. 1 Policy and practice background

3. 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)

4. 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

5. 2 Individual budgets: the pilot programme

6. 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).

7. 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

8. 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

9. 3 Evaluation: design, methods

10. 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? Evaluation dimensions User experience Carer impact Workforce Care management Provider impact Risk & protection Commissioning Outcomes Costs Cost-effectiveness

11. 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

12. 4 Results (a selection)

13. Assessments • FACS remained in place • Growing use of self-assessment and outcomes focus • More integration of information from other agencies

14. 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’)

15. 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’

16. Patterns of IB expenditure

17. Innovative uses of IBs

18. 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

19. 5 Issues for practice and policy

20. 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

21. 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?

22. 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

23. 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…