NWJIP

Lancashire County Council has used the in-Control methodology and resource allocation principles to develop a self-directed support pilot. Work has been ongoing for the last 3-4 years and has involved a whole systems process change including recording, finance and contracts. The pilot project has involved 41 cases, all of whom are adult learning disability service users.

The in-Control framework is being extended to a new range of learning disability services, and with a longer term view for a wider roll out of the model across other service user groups.

What prompted the organisation to develop this approach?

• The project started as a result of local work on person centred planning and the unrealistic expectations placed on care managers in facilitating person centred plans. The project originally concentrated on 'smarter ways of working' in care management. This initial work was facilitated by Simon Duffy, the now National Director of in-Control and led to Lancashire working in parallel with the 6 original in-Control sites.
• The work was based on the principle that people plan better if they know how much they have to spend. It was also felt important that people are clear about what choices they have, and that adequate support planning is in place to ensure that people are safe, but are enabled to live the life that makes most sense to them.
• Another local driver was the desire to ensure a more equitable and fair funding system was in place. The development of the Resource Allocation System (RAS) enables this to happen.
• More recently, government policy such as the White Paper Our health, our care, our say has promoted person-centred care, including the development of individualised budgets.

What has the work involved?

• A group of officers from relevant service groups, e.g. commissioning, assessment and care management, and contracts, was set up in 2005. This became known as the in-Control operational group. In the first instance this was led by a small management group of 3 officers that led the direction of travel, see summary of Lancashire's in-Control model.
• The management group set out the project plan for the pilot which was based around the 7 steps of in-Control. This was presented to members of the operational group and agreed. Key pieces of work to develop the model included: training sessions with care management teams; working with providers to develop service-led brokerage; ensuring Partnerships Boards and Integrated Commissioning Boards understood the process; addressing sub-contracting issues; and further developing and testing the Resource Allocation System (RAS).
• A simple self-rating questionnaire was developed to determine an indicative allocation of funds, based on a points system. This is also referred to as the Resource Allocation System.
• The indicative allocation is presented to a funding panel for an approval in principle. In this way, not only does the individual have a clearer and more transparent basis for planning support, but the organisation can forecast expenditure for each service user.
• Following in-principle approval of the indicative allocation a support plan is developed. This comes back to the panel for final approval to check that the plan considers safety and that good outcomes are likely to arise from it. The support plan may be progressed by one of the following 5 pathways:
  • service user managing their own direct payment
  • family or other circle of support
  • independent brokerage
  • care management
  • service-led brokerage

Once approved, the individual budget may also be managed by one of the above options.

• The development of a reliable Resource Allocation System has been a crucial piece of work. Lancashire's system is a hybrid of the national in-Control RAS3 and RAS4. The funding matrix was developed to set out bands of funds based on points rating. The bands were derived from a costing framework that is constructed from a benchmark rate for new business in Lancashire. A benchmarked hourly rate has been adopted within Lancashire as the payments for domiciliary support to people with learning disabilities. For each band there was a broad model of support which was judged to be what would reasonably be purchased by the indicative allocation and these underpinned the bands of funding levels. The basis of these calculations to determine the range of indicative levels is shown in the resource allocation criteria.

How have things changed for the better?

• Early feedback from the pilot is very promising. It has shown that in-Control methodology can work and that people can have a better life. In each of the pilot cases the outcomes for the person has improved, and in some cases, tremendous outcomes have been achieved for people. The process is now more person-centred and clearer about the outcomes to be achieved for people. Service users are more in control of their lives.
• In several cases a clear financial saving to the pooled budget has also been achieved. An example with one provider shows the reprofiling of supported living using the RAS enabled a saving of 23% to be made. However, whilst the main driver for adopting the in-Control approach is not financial, experience demonstrates that as well as delivering greater customer satisfaction, the approach offers opportunities to re-profile existing revenue commitments more equitably and achieve potential efficiencies and greater clarity around financial consequences of meeting need.
• In addition, as a result of independent and service-led brokerage as well as circles of support, care management capacity shows signs of being freed up, which will increasingly allow care managers to concentrate on the people who most need their support.
• As a result of the positive progress locally, Lancashire is now formally involved in Phase 2 of the national implementation programme and links into much of the North West regional and national work.

What have been the major challenges/drawbacks?

• The numbers involved have so far been small. How many cases will be needed to evaluate the model fully and ensure that the RAS works on a large scale?
• The process is new to everyone and people are learning, so things take longer and it can be difficult to keep momentum with new processes.
• The difficulty of winning hearts and minds, getting ownership at the right level and ensuring that busy people have the capacity to implement something new. Although at times the pace has been slower than anticipated, the benefit of doing it in small steps has been less risk and there have been opportunities to build on the good news stories.
• A number of operational and systems issues will need to be addressed in developing the model further, including enhancements to the client record system and financial and business monitoring systems to properly record and monitor commitments arising from application of the process. Data from the pilot is presently being recorded manually to inform the development of a future electronic system.
• Developments within service contracts to reflect the in-Control approach will need to be considered.

What lessons have been learnt?

• A comprehensive training plan for all stakeholders is needed, including care managers, community nurses, finance staff, provider agencies, family carers and service users.
• Develop strategies for managing independent brokerage.
• Have dedicated support to implement the methodology.
• If the process is applied to existing service users then contingency funding might have to put in to help them become accustomed to this new way of working.
• Greater opportunities for service user wishes to be central to the process, therefore better outcomes for service users.

How might this affect commissioning in the longer term?

• Greater opportunities for building person-centred approaches.
• Clearer financial profiling.
• The opportunity to produce more equity and transparency of funding.
• Able to redress the balance, to ensure that service users are central to the process.

Contact

For more information about this case study please contact Kim Haworth, Integrated Commissioning Manager, Lancashire County Council This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

May 2007