Use of the Indicator of Relative Need

1. Use of the Indicator of Relative Need To RAS or not to RAS

2. The legal framework for personalisation Statutory assessment of needs – will basically proceed as now – but through a self-directed support questionnaire Resource Allocation – will basically proceed as now, but through an apparently objective points-and-pounds or comparison-with-other-clients system Care Planning – will basically proceed as now – but it may be called support planning, or brokerage Routes to the money – will be basically what they are now – either direct payments or commissioned or directly provided services, spot purchases or Individual Service Funds. Charging – as now, with a percentage contribution of your final RA, in light of your means, rather than a charge for each service. © Belinda Schwehr, 2010 © Belinda Schwehr, 2009 2

3. My own personal list of likely challenges…. Self assessment – the less capacity, the less rational this could ever be seen as being – because it ignores the Mental Capacity Act Ignoring FACS guidance about what ‘risk’’ it is that is supposedly being assessed, and the need for a decision about eligibility The relationship between the existence of preventative services, and maybe waiting lists, or charges that are higher than through social services, and refusal to use these services, - and eligibility for a formal care plan Fixed RAs regardless of need, contrary to FACS Arbitrary pounds for points regardless of market anomalies in the area Arbitrary RAS reductions (deflators) because the person has a carer Delegation of care planning to organisations outside the scope of the LA – non-provider brokers, some of whom will be charities Paid providers being conflicted as between clients, their income stream and the carers... Direct payments being spent on non-community care things and unmet need whilst LA investigations occur into why the money has been spent down too soon! Monitoring deteriorating until it becomes a question of “Is the client still happy?” People employing abusing staff because of the absence of CRBs and ignorantly inadequate staff because of lack of training requirements, Safeguarding being curtailed because it’s all down to he client or the family to decide. © Belinda Schwehr, 2010

4. Deployment options for a Personal budget • Direct Payment • Contractual arrangements – but with more user involvement in choice of provider, staff, or call off arrangements • If provider agrees, arrangement can be made for budget to be by DP or contracting in conventional way • Users can choose to have payroll needs managed by LA in-house contracts staff for assistance • Options must take account of legal issues – contractual party agreement, legal liability for payment, procurement rules, standing orders – and duty of care.

5. So what is a RAS • Budget divided by no of users/level of need formula • So allocation = level of need 5/10ths of comparative budget. • Or aggregated cost of three people sharing a LD supported accommodation flat aggregated across all users.

6. Some RAS illustrations

7. RelationshipsThis part is about friendships and people I know – not just my family.

8. Being partofthelocal communityThispart is about doing things in my community – like using local shops, the library, going to the cinema, clubs, community centre, church or other place of worship, helping neighbours, or being involved in local organisations.

9. Running and maintaining my home • This part is about the support I need to manage day to day tasks involved in running a home e.g. housework, shopping, gardening, routine maintenance, budgeting, and paying bills. • Additional information

10. Complex needs and risks • This part is about my actions/behaviour – the things I do, how this affects other people and the support I need to manage this. This may include forgetfulness, confusion, lack of understanding and other factors which give rise to actions or behaviour that may have a negative impact on the safety of others. This part identifies the support you need to manage and minimise any negative impact.

11. © Belinda Schwehr, 2010 How will we know when our RAS is ready? The resource allocation calculation can never be more than a management accounting tool, because it’s LEGAL principles that govern what each person with assessed eligible needs for community care services must be given - eventually. Calling it an indicative guideline works, but only if it is supported by a transparent process that is procedurally fair, by which that guideline can be challenged by those who want or need to prod the system a bit further (isn’t that like - er – a funding panel? How very new!) A definitive legal resource allocation mechanism would need to bear some form of evidence-based rational relationship to the REAL cost of providing the services assessed as needed, so can never pre-date the conclusion of the assessment. Any non-duty based allocation of public sector discretionary funds (eg Carers’ Direct Payments, grants or Well-Being money) can be as arbitrary as the LA likes – so long as they can stand the political fall-out.

12. So issues • Self assessment • Risk and eligibility • Prevention versus higher level needs • Points for pounds • RAS regardless of needs • RAS reductions (deflators) – does SDS = Savings? • Needs/ aspirations/duties/care and support

13. So what would help • IoRN and RAS? – IoRN has a track record in measuring needs, in workforce planning, and in commissioning data. RAS does not do top and bottom of needs. • Other tools and outcomes frameworks - Talking Points are available • Re-ablement and goal setting approaches – Meyer; Canadian OT Tool are in use • And IoRN already built into SSA in most partnerships • And application to other service user groups