Personalised SupportPersonal Budgets & Flexible Support
The best way to think about personalised support is not by starting with government policy.
This is an ethical issue, which has been driven forward by radical grassroots action.
50 years ago disabled people started demanding the right to be citizens.
Two generations of battle to close institutions and develop personalised forms of support instead.
Today there is still much to do
Combine with lobbying for political and legal changes activist have created practical alternatives. For people with learning disabilities some of the most important include:
1. Individual service design, planning and policies
2. Managed personal assistants and shared management
3. Individualised funding (e.g. Individual Service Funds)
4. Supported decision-making and family leadership
5. Access to ordinary housing
6. Quality checking by people and families
Recent survey of 156 providers of personalised support helps reveal some of the key elements involved in providing personalised support.
WHAT IS? NOT
Individual design slotting people into a placement
Creative planning another ?@*&^ person-centred plan
People/families make decisions its the organisations way or the highway
Quality checking professional knows best
Matching staff to people generic support roles
Individualised policies organisational health & safety rules
Full housing options weve got a lovely group home for you
People/families recruit staff staffing is our business
Individual budget protected money is a mystery
Direct management possible their our staff, not yours
Not all personalised support providers were using Individual Service Funds (ISFs) yet. However the organisations that had been using ISFs the longest are most likely to be doing all the key elements of personalised support.
Why does individualised funding help?
Focus - The solution to one persons needs doesnt get muddled up with others
Creativity - You can create solutions around that persons community and dreams
Trust - Everyone believes that the persons budget is safe and changes benefit them
Inclusion Glasgow worked with people with complex disabilities, moving from institutions to individually designed support solutions in the community.
Research on the work of Inclusion Glasgow demonstrated high levels of efficiency, improvements in peoples lives and lower costs over time. There was a 46% reduction in hours of support over a 5 years period.
Choice Support converted a block contract for 83 people into 83 personal budgets - managed by the organisation - ie. Individual Service Funds (ISFs).
This work was associated with reduced costs and improved lives.
Like many service providers, Choice Support were happy to accept short termination periods on that contracts - and the ability of people to end those contracts - instead of risky block contracts subject to tendering and procurement.
Choice Support converted a large block contract into 83 individualised services, with a saving of 28% over 3 years.
Social workers and support staff came to see the process as personally rewarding.
Today Glasgow Council are threatening to put Margaret in a care home because her package of support is too high.
Her carers and independent citizens are being denied the right to advocate for Margaret.
Austerity and cuts to social care
Procurement and tendering practices
Lobbying by residential care industry
Fragmented advocacy movement
In a 3 month period 25.9% of inpatients had harmed themselves 21.0% of inpatients had suffered an accident in the last 3
months 22.2% of people had suffered physical assault in the last 3
months Physical restraint had been used 34.2% of people in the last 3
months 11.4% had suffered seclusion in the last 3 months 56.6% of people had been the subject of at least one incident
involving self harm, an accident, physical assault against them, hands-on restraint or seclusion during the last three months
Antipsychotic medication used regularly or at least once in the last 28 days for 68.3% of the people in the units
confused responsibility & liability
We still spend most of out social care funding on residential care (but that is now dropping)
Many charities unwilling or unable to campaign
Different disability groups competing
Government threatening behaviour (e.g. lobbying act and other restrictions on free speech)
Confusion about what kind of system people want to defend (e.g. residential care vs. inclusion)
System confusion (e.g. children vs adults; health vs social care)
Public and media ignorance
Some commissioners, like Dorset, see theres a better way
Care Act 2014 and NHS personalisation supports the change
Limited funding can be used more effectively with creativity and focus on community connections
There is effective on-going pressure around ATUs etc.
Many providers want to break out of long-term block of framework contracts and be accountable to people.
Recent work in Calderdale has led to the use of ISFs becoming the main way that home care is provided. Over time this is encouraging more innovative and flexible support from service providers.
MOST IMPORTANTLY - to provide creative and flexible support to people as citizens is what people want and its much more fulfilling
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