Agenda item

The Chairman introduced the report and thanked the witnesses for attending the meeting. The witnesses in attendance were:

 

·        Chris Hampson – Look Ahead, Executive Director of Strategy, Performance and Operations

·        Colum Friel – Look Ahead, Head of Operations Mental Health Services

·        Ceri Sheppard – Look Ahead, Transformation Manager

·        Angela Wegener Chief Officer, DASH

 

Look Ahead

Chris Hampson provided an overview of the Look Ahead organisation. The following points were noted:

·        Look Ahead had provided vulnerable customers with high quality accommodation and the care and support services they required to live independently for over 30 years.

·        Look Ahead worked with people who were amongst society’s most vulnerable and included:

1.      young people, care leavers and teenage parents

2.      people with mental health issues

3.      people with learning disabilities

4.      homeless families, single homeless people and rough sleepers

5.      women and children fleeing domestic violence

6.      people with substance misuse issues

7.      people with offending histories.

·        Look Ahead had worked in partnership with 28 Boroughs in London and the South East and several primary care trusts. Last year Look Ahead supported over 5000 people.

·        The accommodation-based support and floating and outreach services offered support to people around:

1.      preventing repeat homelessness through tenancy sustainment

2.      seeking specialist support for drug and alcohol issues

3.      mental health needs

4.      managing money and accessing benefits

5.      finding meaningful occupation and developing social networks

6.      accessing education, employment and training and activities in the local community.

·        Look Ahead had enabled socially excluded people they supported to transform their lives in positive ways. By doing so[MSOffice1] , clients had been empowered to play an active part in their local community and to live more independent lives.

Look Ahead was customer focused and assisted clients to make choices and take control of their own support which could involve.

·        Selecting the person who supports you

·        Choosing the time and location of your support sessions

·        Having control over the activities budget where you live

·        Having a say in how your service is delivered

 

A key aspect of helping clients to make these choices was facilitating the move away from block contract commissioning to personal budgets. It was noted that Look Ahead were currently in discussion with a number of Local Authorities about the ways in which they were managing this transition.

·        It was noted that personal budgets only applied to those clients which were FACS (Fair Access to Care) eligible, although most of Look Ahead’s clients would not be eligible for a personal budget.

·        Look Ahead aspired to assist as many users of personal budgets as possible and had conducted a pilot study last year. This had involved 240 service users across all clients groups and delivery models to see how service provision could be personalised for them.

·        Learning points from the pilot study had shown how important choice and flexibility were.

·        Look Ahead had experience of assisting 25 clients with personal budgets which were mostly administered by the respective Councils. These budgets ranged from £5k to several times this amount and mainly centered on those clients with disabilities. At this early stage, users experiences with personalised budgets had been mixed. Numerous examples of innovative uses of personalised budgets were cited including the case of a client who had chosen to spend part of their allowance on attending ‘gigs’ for increased social interaction. In some cases, client’s circumstances had not markedly changed since they had adopted a personalised budget.

 

Colum Friel – explained personalised budgets for Mental Health clients were not as advanced as those for clients with disabilities but were catching up quickly.

 

In response to a question about the under development of the current commissioning market place, the Look Ahead representative explained that ensuring the market developed and there were sufficient market coordinators in place was one of the greatest challenges facing all Local Authorities. Ensuring support plans were up to date and were flexible was also key to developing the marketplace so that the market could grow in response to clients changing needs.

 

Look Ahead suggested that zero based contracts were a flexible way forward but in their experience, not all Local Authorities had shown a willingness to buy into this mechanism.

 

It was noted that one of the key barriers to the adoption and development personalised budgets was the risk aversion mentality of many Local Authorities and in particular the safeguarding concerns which were prevalent in managing cash for clients with either disabilities or mental health needs. Only when risk aversion could be overcome would the commissioning market truly develop.

 

Members asked how these barriers could be overcome? In response, Look Ahead explained that a change of organisational culture was required  and a sea change of attitude amongst staff, to enable staff to take more informed risks than they had been used to doing previously. It was noted that this issue was a regular experience across all Authorities as all staff were naturally aware of statutory and personal responsibility they had to manage when assisting every client.

 

Look Ahead suggested that block contracts were an easy or safe option through which to procure services and that a combination of the innovative use of the voluntary sector and innovative commissioning were required if the market was to develop at a quicker pace. Allied to these conditions, it was suggested that every Local Authority would need to ‘experience’ the marketplace and make judgements about were there were gaps in service provision to assist service providers. One way of doing this would be to ensure providers worked with Authorities to ensure a Directory of Services was maintained  which could be used to identify were additional marketing activity was required.

 

Look Ahead explained that conventional thinking indicated that market development would be driven by the individual client. However, their experience had suggested that market development would be driven through a combination of support plans and brokerage and the market responding to these needs.

 

A further key challenge which was highlighted related to costings and pricing of services and it was acknowledged that this was difficult to accomplish in an underdeveloped market place.

 

In response, Officers explained they were working on compiling a list of providers (including details of the services provided and the prices of these) on a West London level and capturing this on software so that these details would be available on-line through public libraries to all support planners. The intention of this approach would be to allow users to post feedback comments on their experiences and thereby regulate the marketplace. Quality providers with positive feedback would flourish whereas those with negative feedback would do less well.

 

While Members agreed this was a positive approach, concerns were raised at the likely timescales required to achieve this desired outcome. In response, officers explained they were working on developing a practical framework to enable Social Workers to manage greater risks and this culture change had already been integrated into officer training programmes.

 

Ceri Sheppard explained Look Ahead had found tremendous resistance amongst some Social Workers and especially those from block contract backgrounds. Members agreed that managing the change programme was a significant challenge and advocated that incremental change was the most sensible way forward.

 

A further factor influencing the speed of market development across Authorities was the culture at each organisation. Whereas some would be target driven, others might focus on the build up of relationships and the importance of developing infrastructure. Members were conscious that any risk assessment approach would need to ensure both users and staff were protected and there were protocols in place to support social workers. This also underlined the importance of thorough support planning and for this to be effective, ensuring risks were identified at an early stage. Members  agreed it was important that risk assessments would need to be regularly reviewed and maintained as ‘living documents’

 

Officers highlighted it was important to note the Statutory Duty of Care had not changed. Look Ahead explained that one of the difficulties faced by staff was there was often reluctance amongst clients to speak out when their support plan was formulated and so to enable support plans to be as effective as possible clients would need to be encouraged to speak out in future.

 

Members asked whether there were any specific disadvantages of having a personal budget. In response, Look Ahead explained that some clients were not even aware they had a personalised budget and so every effort had to made to ensure the support plan made these options clear to the client. Members attention was drawn to a pilot which had occurred in tower Hamlets about 3 years go. During this study, one of the major criticisms of a personal budget was the users spent money on activities that were linked but peripheral to their support plan and money could have been better spent elsewhere. However, it was pointed out this had been a learning experience for all concerned and none of these early decisions had resulted in actual harm.

 

In relation to establishing what a personal budget might be, it was highlighted that a personal budget is generated by an  assessment to identify eligible needs.  The assessment is converted into a monetary amount using a Resource Allocation System (RAS) . In which case, if the assessment is  not as accurate as possible then the total number of points awarded to a user might not be reflected in representative budgetary figure. It was also noted that physical disability assessments were in some cases easier to assess than for those users with mental health needs and it required a skilled and experienced social worker to illicit what certain needs might be.

 

DASH – Disablement Association Hillingdon

Angela Wegener provided an overview of DASH. The following points were noted:

·        DASH was a user led organisation providing advice, support and information that enabled disabled people to make choices about how they lived their lives.

·        DASH had established young people’s scheme called the Transitions Project. Members were informed that DASH had been awarded funding by the City Bridge Trust, to work with young people in Transition, from April 2009. This project was aimed at young people with a disability aged 16-25 years and their families, and offered advice and support in all the areas that affected young people of this age group such as:

1.      Further education

2.      Work experience

3.      Employment

4.      Benefits

5.      The change over from children to adult services

6.      Independent living

7.      Volunteering

8.      Leisure activities

9.      Gap year

10. Travel training

11. Anything else of relevance to this age group

·        One of the findings from the Transitions Project was that disability was not the sole driver and a person’s age was also very significant. DASH found that the level of expectation was significantly higher when people were younger and one of their key concerns was the desire for work experience.

·        Most younger users of DASH did not attend Day Centres and did not go on to use Council Social Services when they reached adulthood.

·        Members heard that one of the most difficult messages to convey to parents and carers of people with disabilities was the difficult balance which had to be struck between dependence and risk. The Committee heard that many DASH users felt empowered and more confident when they attended activities with limited assistance and asserted their own independence.

·        Recent work by DASH included establishing closer ties with Hillingdon Mind and linking health and relaxation courses in Yoga to luncheon facilities based at Christ Church. Members asked whether this was the kind of activity DASH was looking for from Local Authorities. In response, Members heard that assistance with travel training and learning to use mobile telephones were important skill sets to allow a user to become more independent while remaining safe.

·        Members explained that in their experience, similar organisations (to DASH) elsewhere had pooled resources to make savings and efficiencies where possible and by doing so had been able to assist users with periods of recovery or asserting their independence. Ultimately though, it was recognised that innovative use of the voluntary sector would be required to lessen the reliance on statutory services.

·        The Committee heard that while there had been a large reduction across London in the number of day care services viable. Alternative options had to be found elsewhere. The Committee agreed that day services were an important element in providing a user with the continuum of care and should be available to those that needed them.

·        The point was made that day services facilities were important for several reasons including respite for the carer and social interaction for the user, but under the FACS criteria those users with low and moderate needs would not meet the criteria for personal budget.

·        Members were reminded that one of the key drivers of personalisation was to provide improved choice and control to people’s lives. It was noted that support plans needed to be flexible to allow these to adapt as users needs changed over time.

·        The Committee asked whether (officers) shadowing organisations like DASH  would be useful learning exercise. In response, officers explained that Hillingdon Academy students as well as officers within the Transformation Programme already undertook shadowing when appropriate.

·        A final point was made with reference to service directories which Look Ahead and DASH had both mentioned. The Committee agreed these needed to be accessible and show users real examples of what people had done in the past to help inform users choices and decisions.

 

Resolved –

1.      That the Committee notes the information provided and use this to inform their review.