Personalised support services for disabled people: What can we learn?

Version 3 | Internal use only © Ipsos MORI

Margins of Error

Personalised Support

services for disabled

people: What can we

learn?


Version 3 | Internal use only Learning from the Right to Control Trailblazers:

Helping disabled people exercise choice and

control over their support

Claire Lambert , Ipsos MORI September 2013


What is the Right to Control?

• The Right to Control gives disabled adults the legal

right to exercise choice and control over certain

public funding they may receive.

• It covers 6 funding streams:

–Adult Social Care

–Supporting People

–Disabled Facilities Grant

–Access to Work

–Work Choice

–Independent Living Fund



Under the Right to Control, disabled people can:

• Receive the support the public body would have provided

before the Right to Control

• Ask the public body to arrange alternative support on

their behalf

• Receive a direct payment and arrange their own

support

• Have a mix of these arrangements



• For people eligible for more than one funding stream,

the Right to Control also aims to streamline the

customer journey (avoid duplication in assessment,

support planning and review).

• Tested in seven Trailblazers: Barnet, Essex,

Leicester, Manchester Area Partnership, Newham,

Sheffield and Barnsley, Surrey.

• All new clients have the Right to Control (for the

ILF it is all clients on review).

• Initially for a period of 2 years, starting December

2010, then extended to December 2013


The evaluation had 3 components

Process study to look at delivery and

implementation

• 2 waves of qualitative interviews with disabled people, carers, staff, providers and ULOs (315 interviews)

Impact study to measure impact of the RtC on clients’

outcomes

• Survey of RtC clients and a comparison group (3,282 interviews) in Autumn 2012

Economic impact analysis

• Measuring the costs and benefits of the RtC

• Break-even analysis

Input from evaluation co-production group and steering group throughout


Why is the Right to Control important?

‘Although people welcome choice in the

services they use, there is a minority of

people who are excluded from these benefits,

often because they lack the confidence,

information, or the advice they need’

David Boyle, The Barriers to Choice Review


59% 22%

8%

5% 4%

1%

Q7. “It is important to have a choice of (service)”

Having a choice seen as important across services

Source: Ipsos MORI

Strongly agree

Neither/Nor

Strongly disagree

Service

School

Social

care

Hospital

GP

surgery

Agree 94% 83% 77% 80%

Disagree 3% 7% 11% 11% Tend to agree

Tend to disagree

Base: All those who have changed/used service (1,485), 2012

81%

9%


46%

51%

3%

Q6. Did you select the school/provider of support or social care services/GPs

surgery/hospital from a number of options or was there no choice at all?

But choice of service is limited in social care…

Source: Ipsos MORI

Yes – selected from a number of options

No choice

Choice by service

School Social

care

Hospital GP

surgery

Yes 83% 27% 35% 57%

No choice 15% 65% 63% 41%

Don’t

know

2% 9% 2% 2%

Don’t know

Base: All those who have changed/used service (1,485), 2012


7% 8%

9%

24%

51%

1%

Q7. “It was difficult to make a choice of (service)”

…and more difficult to make

Source: Ipsos MORI

Strongly agree

Neither/Nor

Strongly disagree

Service

School Social

care

Hospital GP

surgery

Agree 22% 41% 6% 13%

Disagree 71% 44% 82% 78%

Tend to agree

Tend to disagree

Base: All those who selected their service from a number of options (728), 2012

15%

75%


Some examples of

impact reported by RtC clients

Better value for money if

direct payments

Choice is a pleasant

surprise, even if not used

Feeling empowered

Growing confidence

Sacking bad care providers

More flexibility to change support

Better support

Better relationships

with paid carers

Getting back into paid

employment

Exercising the RtC is beneficial for disabled people


But few disabled people exercised their right

Looking back at the four options available to people under

the Right to Control, most chose the first one:

• Receive the support the public body would have

provided before the Right to Control

• Ask the public body to arrange alternative support on

their behalf

• Receive a direct payment and arrange their own support

• Have a mix of these arrangements


Meaningful choice of providers or support

Information to make confident choices

Help in managing their support

Knowing they could

request changes

Four conditions need to be met

Conditions needed before disabled people

could exercise their Right to Control successfully


Helping disabled people exercise choice over

their support

Disabled people need to be told that they can have

choice over their support, that they can request a

change of provider, or a review.

Timings matter.

Knowing they

could request

changes

Provide practical examples of how other disabled people

have exercised choice or used direct payments

Provide information about providers available locally, what

they offer, ballpark quotes, and feedback from other users

Information to

make

confident

choices


Helping disabled people exercise choice over

their support

Third-party support needed to help disabled people deal

with the administrative and legal aspects of direct payments.

Ensure they can ‘ask the public body to arrange

alternative support on their behalf’.

Managing their

support

Choice over equipment and adaptations in DFG, Access

to Work

Choice of providers – in particular for people with complex

needs, and people in rural areas.

Look at how people may be able to pool budget across

funding streams

Meaningful

choice of

support and/or

providers


Developing the provider market

• To offer choice to disabled people, Trailblazers had to

move away from block contracts or framework

agreements. This sometimes meant terminating

contracts early or renegotiating them, and widening

the providers’ offer

• Large, well established providers were less willing to

change their offer

• Developing the provider market is a slow process and

very time consuming

• Nonetheless, Trailblazers had made various efforts to

stimulate the market

Online search tools in Barnet and Bury

to link disabled people to new

providers

New commissioning

staff dedicated to liaising with providers

Drawing up alternative provider

lists for delivery staff to offer to

disabled people


“The ability to make that happen may take 10 years though because the market has to change. The block contracts that we’re uncoupling from in social care and Supporting People, the way DWP commissions and has a prime provider, that would need unpicking.”

Strategic staff

“A lot of these small providers, they’ve got a real passion about helping these customers. I phoned someone up and I told them about the RtC coming out in a couple of weeks’ time, and when I went to see them two weeks later they’d produced leaflets, support plans and business plans.”

Commissioning staff


Things that help make a good support plan

Instil a sense of progress over time

Think creatively, beyond standard

provision

Consider mainstream

services as well as disability services

Involve ULOs/peer support workers

Speak to other family members to

get a good understanding

Understand the person’s life and

aspirations

Support planning is key to facilitate culture change


“They were really good with me, asking questions, finding out what I wanted to do, because what I do is quite specialised. It was time consuming, but it was worthwhile.”

Work Choice client

“It’s something I could always look back and think, yeah, that’s what I’m doing it for. I need things to jog my memory, especially when I hit a low patch … .”

Client for SP, DFG and ASC


…and so is ULO involvement

• A more neutral place for disabled people to start

discussing employment than Jobcentre Plus

• More creative/tailored support plans that better meet

disabled people’s needs (but they may not get approved)

• Good understanding of the local provider market

• Easy access to informal feedback from disabled people

about local providers

• Can bridge gaps between funding streams that are not

used to working together

• Can help speed up the culture change among staff and

disabled people


“DEAs, quite regularly some of them, would come in and ask us for advice. ‘We’re going to see someone tomorrow, what do you suggest is best for them?’ And that’s good.”

Local co-production team member

“The questions that we get from different staff now are more positive questions. They’re not carrying assumptions that disabled people can’t, they’re asking us how disabled people can, and what needs to be put into place.”

Local co-production team member


Summing up

• Four conditions need to be met to help disabled people

exercise choice and control over their support:

– offering them a meaningful choice of provider or support;

– providing information to help them make confident choices;

– offering them help to manage their support; and

– making sure they know they can ask for changes to their support.

• Work toward these is already well underway in the

Trailblazers and elsewhere, but some of these are long-

term goals and will take time, leadership and a sustained

commitment from all those involved.


More details on the evaluation report

• http://odi.dwp.gov.uk/odi-

projects/right-to-control-

trailblazers/research-and-

statistics.php

http://odi.dwp.gov.uk/odi-projects/right-to-control-trailblazers/research-and-statistics.php















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Personalised support services for disabled people: What can we learn?