Self directed support and personal budgets: enabling risk, ensuring safety

1. Self directed support and personal budgets: enabling risk, ensuring safety

2. Personalisation: new risks, old systems? • Risk averse or avoidant practice puts people at risk • Risk of people losing independence, choice and control • An example • Putting people not organisations first

3. Personalisation: old risks, new systems? Risk management dilemmas existed before personalisation and personal budgets: • Balancing empowerment and protection; self-determination, independent living and safeguarding • Service quality and regulation • Financial abuse and misuse of funds • Abuse or neglect • Contingency planning and back-up arrangements

4. Personal budgets: a popular myth • Personal budgets are not just direct payments or ‘cash for care’ • They can also be taken by way of: • An ‘account’ held and managed by the council in line with the persons wishes • An ‘account’ placed with a third party (provider) and ‘called-off’ by the user in direct negotiation with the provider • As a mixture of the above. IDeA/ADASS/DH/LGA 2009

5. Independence, choice and risk ‘The governing principle behind good approaches to choice and risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same...Person-centred planning approaches identify what is important to a person from his or her own perspective and find appropriate solutions. We commend person-centred approaches for everyone.’ Department of Health 2007

6. Putting People First ‘One of the core components of a personalisation system is an effective and established mechanism to enable people to make supported decisions...It needs to be recognised that organisations and professionals need to move away, wherever possible, from making decisions for people and towards a role that informs, facilitates and empowers people to think about how they wish to live their lives...the goal is to get the balance right moving away from being risk averse while still having appropriate regard for safeguarding issues.’ Department of Health 2008

7. No Secrets • ‘Safeguarding must be built on empowerment – or listening to the victim’s voice. Without this, safeguarding is experienced as safety at the expense of other qualities of life, such as self-determination and the right to family life. • Everyone must empower individuals but safeguarding decisions should be taken by the individual concerned. People want help with options, information and support. However, they wanted to retain control and make their own choices.’ Department of Health 2009

8. Mental Capacity Act 2005 • ‘Empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process • Allowing people to plan ahead for a time in the future when they might lack the capacity, for any number of reasons, to make decisions for themselves.’ SCIE 2009

9. Risk enablement and personal budget schemes: what does the research say? • Perspectives of people who use services are largely absent in research about social care and risk • Practitioners and families have greater influence in defining risk and risk management approaches • Too early for findings on risk enablement strategies for personal budgets in UK - no evaluation of risk enablement panels published yet • Lessons to be learned from US ‘Cash and Counselling Program’, direct payments, person-centred planning and the relationship of care management and risk management

10. Risk enablement and personal budget schemes: what does the research say? • IBSEN study did not present evidence of increased risk in the pilot implementation of personal budgets • Emerging research suggests that a rebalancing of social work resources towards frontline activity could enhance overall organisational risk management and safeguarding. • Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement into relationship-based, person-centred working.

11. Risk enablement and personal budget schemes: what does the research say? • People using services should be enabled to define their own risks and empowered to recognize, identify and report abuse, neglect and safeguarding issues with the support of frontline staff. This approach should be an integral part of self directed support, including assessment and regular outcome review. • One indication of a supportive system is one which clearly incorporates self directed support with safeguarding policy and practice, with abuse detection and risk enablement training for staff, people using services, carers and families. • It appears that risk enablement in the context of self directed support and personal budgets should be approached as an integral part of the transformation process, rather than relying ‘bolt on’ solutions to existing systems which do not place the person using the service at the centre.

12. Risk enablement and personal budget schemes: what does the research say? • Research evidence is showing that if frontline practitioners are disproportionately engaged in protecting organisations from fraud when administering direct payments, this will impact on the capacity of those practitioners to engage with individual service users to identify safeguarding issues and enable positive risk taking. • Emerging research suggests that a rebalancing of social work resources towards frontline activity could enhance overall organisational risk management and safeguarding. • Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement into relationship-based, person-centred working.

13. Emerging practice • An intergrated personalisation and safeguarding framework • The role of the social worker • Risk enablement panels • Personal budgets, risk management and organisational transformation

14. Two key messages • ‘Rather than try to calculate the incalculable, social workers need to regain their former status as experts in uncertainty. They should develop mutually trusting, respectful relationships with their clients, make fine judgements about risk and dare to work creatively and innovatively.’ (Stalker 2003) • ‘Care management processes and workforce skills, we were told, needed to be refocused on communication, empowerment and enabling people to take considered risks.’ (Department of Health 2009)