NWJIP

What prompted the organisation to develop this approach?

• The local authority had received a zero star rating. It was also worried about the potential impact of FACS criteria, and increasingly concerned about the slow take up of direct payments.
• Another local driver was the desire to ensure a more equitable and fair funding regime was in place. A stronger link between identified needs and packages of care was wanted.
• The opportunity to become involved in phase 2 of in-Control and to become an individual budgets pilot site.

What has the work involved?

• A small team was created to undertake the work, including a senior finance manager, thereby recognising the direct link between RAS and the monetary aspect.
• Rather than being introduced as a pilot for one particular client group or area, it was decided that a single RAS should be embedded into the organisation as soon as possible. The RAS was tested by assessing existing clients against a banding scheme and, after much refinement, a straight forward points system was designed to help decipher individuals' needs and make sure resources were appropriately allocated.
• An external consultant was recruited to help involve staff in the process; explaining the changes being planned and the reasons why, and inviting individuals to participate in the implementation process.
• To illustrate how things might be done differently and encourage shared ownership and decision-making, all stakeholder groups were consulted. For example, providers were invited to attend risk panel meetings.
• In order to take into consideration care managers' needs and ensure they had the confidence and ability to effectively deliver the new system, regular support ws offered through 'drop-in' and 'support planning' sessions over a 6 month period.
• The RAS was applied across the board to all service users entering the service and those being reviewed. Individual budgets are raised very early in the care management process, and since March 2006 all service users complete a self assessment as a matter of course when they are new to the service, and at review.
• In order to highlight the prevalence of service users' needs being under or over assessed and ensure the appropriate allocation of resources, information collected during the Single Assessment Process in systematically checked and validated. An allocation panel signs of each allocation of resources, whether a care package or direct payment.
• To ensure openness and transparency, and to make sure service users' wishes are being fully taken into consideration, individuals are invited to attend the allocation panel.
• The risk enablement process assesses the level of risk and issues relating to the support plan, modifications are made if necessary.

How does the system work?

1. A straight forward points system is used to decipher the level of an individual's need.
2. The individual is supported to complete his or her self-assessment.
3. Information from this self-assessment is systematically checked and validated.
4. The Allocation Panel signs off each allocation of resources, service users are also invited to attend this panel.
5. Individuals complete a support plan.
6. The risk enablement process assesses the level of risk and issues relating to the support plan, modifications are made if necessary.
7. An individualised budget agreement and statement is established.
8. A contract is made between the local authority and the person with the individual budget.
9. An annual monitoring form is completed by those directing their own support and Oldham then carries out an audit on a selection of returns.

How have things changed for the better?

• A redistribution of resources across the board has led to a reduction in the number of high cost packages, and a more equitable system for all people with support needs.
• Gains in efficiencies achieved during the first year were reinvested in more preventative work.
• By involving service users in the development of their own support plans, they are more likely to be satisfied with the outcome.
• Some service users have gained independence and now identify that they no longer need their full allocation.
• By encouraging greater independence for those service users in a position to manage their own budgets and care plans, the authority is in a position to focus more on service users with higher levels of need.
• The system is much more open and transparent. Service users can have direct payments, in-house services or external services. Many people still choose to have in-house services, but they have clearly chosen to do so and this has resulted in greater staff morale for provider services.

What have been the major challenges/drawbacks?

• Greater resistance to change than was anticipated amongst care managers and in-house and external providers has led to varying levels of support.
• The challenge of identifying those individuals who are able to 'self direct' and with whom the authority can make minimal intervention so that its capacity, time and attention can be focussed on those people who are at higher risk.
• An increasing amount of market management work has been necessary to ensure the right support and services will be delivered in 5 or 10 years time, particularly around assistive technologies and telecare.
• Challenges in providing an equitable allocation system across the board, which is at the same time sustainable and affordable.
• Being able to accurately cost support plans. We didn't always know what the unit costs of support were, especially for in-house services, and there was an initial mind set that non contracted services didn't count - they were free on the support plan.
• A lack of confidence amongst care managers in delivering the new system.
• Difficult to achieve a total transformation in the way services are delivered to ensure better outcomes for service users.
• Developing brokerage so that it is a function with flexibility.

What lessons have been learnt?

• The difficulties experienced in implementing direct payments probably helped us with individual budgets - if a service user has reached crisis point, it is not a good time to start the discussion. Direct payments were not anchored in care management, and individual budgets were considered earlier in the assessment process.
• The people who have proved to be the real 'champions' of the new system are those who were sceptical about it in the first place, having witnessed better outcomes for service users and a greater degree of freedom.
• Service users are the best advocates of this process.
• The importance of shared ownership and decision-making from the start.

How might this affect commissioning in the longer term?

• Ultimately, the authority envisages only commissioning high cost packages for high risk service users.