Minimum Process Framework - Think Local Act Personal

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Minimum Process Framewo rk October 2 011

Think Local, Act Personal is a sector-wide commitment to moving forward with personalisation and community-based support, endorsed by organisations comprising representatives from across the social care sector including local government, health, private, independent and community organisations. For a full list of partners visit www.thinklocalactpersonal.org.uk

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Adult Social Care - Minimum Process Overview Prevention

Click on a Process Step for Detail Supporting Recovery & Maximising Independence

Staying in Control of Your Support

Services Available to All (i.e. Universal / Whole Community)

Access to Good Information

Includes access to simple support (without professional assessment): · · · · · · · ·

Advice and Help to Choose

Gardening Shopping services Home maintenance Telecare Simple aids Vaccination Social networks Benefit maximisation

Service Shaping and Supply

Services Available to Some (i.e. via Local Authorities) · Signpost to Universal Services (see above)

Crisis/Rapid response

·

Shared Health and Social Care service Immediate support for sudden and severe changes in need Financial assessment and benefit check

Initial Customer Contact

Enablement

·

Reduce or eliminate the need for ongoing care

On-going On-going eligible eligible needs? needs?

Yes Allocate resource based on need

No

Signpost to Universal Services (see above)

Budget allocated and approved

On-going Support, Review and Protection

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Services Available to All (i.e. Universal / Whole Community) Access to Good Information

Points to Consider · Spans the 3 domains of Prevention; Supporting Recovery & Maximising Independence, and; Staying in Control of your Support

Individual, carer and/or family

Vol Orgs / ULOs / Providers

·

Council Contact Centre

Online Information Portal

Query resolved or person signposted

Suitable for enablement or eligible for on-going care

Back to Overview

Consumer focussed information about healthy living and care and support to help people understand what could be available to them

· Includes information on the quality of services that can assist people to choose the service that is right for them · Access to self-serve tools, such as online equipment catalogues and universal services by category browsing and searching is important. People eligible for on-going funding from an authority may comprise only a

minority of those using care and support services

·

Includes good financial information which may help people who fund their own care better utilise their money, and avoid becoming dependent on state funding at a later time. Information has been produced in conjunction with Solla, Age UK and Counsel and Care explaining how to get trusted advice in relation to personal finances and paying for care (“Paying For Long Term Care in England” – see useful links)

· The study ‘People Who Pay For Care’ (see useful links) highlights that the income of self-funders can be maximised by ensuring they are receiving benefits to which they are entitled and have access to independent financial advice to manage their resources. Service Providers can be a good source of information if people are expressing concern about their funds becoming depleted

Examples · Hampshire County Council Care Choice: http://www3.hants.gov.uk/carechoice.htm ·

Oxfordshire County Council Getting Care

· Kent County Council Advice and Guidance: http://www.kent.gov.uk/adult_social_service s/your_social_services/advice_and_guidance. aspx · askSARA: http://www.asksara.org.uk/

Useful Links · Think Local, Act Personal (TLAP) website – Information and Advice: http://www.thinklocalactpersonal.org.uk/Bro wse/Informationandadvice/index.cfm · TLAP website – Self-funders: http://www.thinklocalactpersonal.org.uk/Bro wse/Self-funders/index.cfm · People Who Pay for Care: http://www.thinklocalactpersonal.org.uk/Bro wse/Selffunders/index.cfm?parent=8609&child=8647 · Paying For Long Term Care in England: http://www.thinklocalactpersonal.org.uk/Bro wse/Self-funders/?parent=8609&child=8385

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Services Available to All (i.e. Universal / Whole Community) Advice and Help to Choose

Needs and outcomes identified

External advisory services

Council advisory services

Online Market

Services available

Points to Consider ·

Spans the 3 domains of Prevention; Supporting Recovery & Maximising Independence, and; Staying in Control of your Support

·

More specialised advisory services that help people to explore options including peer support, use of charities and specialist organisations (e.g. dementia, neurology etc – drawing on a range of specialised services)

·

Providing assistance to choose and secure the right support

·

Easily available guides and tools should allow people to plan for themselves. Placing these tools online will also allow people who self-fund to take advantage of information and techniques they would perhaps not have previously had access to

·

Planning for support should be proportionate to need, and not necessarily involve professionals. Peer support works well in many cases and may lead to an increased take-up of direct payments for those that are eligible

·

People should have information on how to change services if they are not working for them

Services not available

· Market development opportunity

Back to Overview

·

askSARA: http://www.asksara.org.uk/

Useful Links Consider Avoiding:

Purchase Services

Examples

Relying on traditional internal authority ‘brokerage’ services. Unless this team has full access to a wide ranging and developed market then there is a high probability that only established traditional authority services will be purchased. Peer support may result in a more individualised and creative use of personal budgets

·

Think Local, Act Personal website: http://www.thinklocalactpersonal.org.uk/Bro wse/SDSandpersonalbudgets/Supportplannin g/index.cfm

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Services Available to All (i.e. Universal / Whole Community) Service Shaping and

Supply

Feedback on existing services from Individuals, carers and families

Demographic Information & projections (e.g. JSNA. POPPI, PANSI)

Market Shaping

Feedback on services not available from Individuals, carers and families

Existing and evolving Community Capacity

Points to Consider ·

Spans the 3 domains of Prevention; Supporting Recovery & Maximising Independence, and; Staying in Control of your Support

·

Facilitating market development that supports and is built around users, families and carers

·

Includes building community capacity

·

! full range of services (including ‘universal’ services) should be available online so customers can research and purchase or access them directly. This approach also supports people who self-fund

·

Support services will affect the take-up of people arranging their own services for those eligible for Personal Budgets. Good quality and appropriate support services will help people requiring care services to identify what support may be needed and then assist in getting this support (e.g. recruitment, payroll service etc)

Examples ·

Useful Links · ·

Back to Overview

Northampton - Hampton House Case Study: http://www.thinklocalactpersonal.org.uk/pdf Writer.cfm?cid=8854&renderTitle=Blueprint %20Case%20Study%20PDF

Think Local, Act Personal Website: http://www.thinklocalactpersonal.org.uk/Bro wse/commissioning/ Think Local, Act Personal Website – Provider Blueprint: http://www.thinklocalactpersonal.org.uk/Bro wse/blueprint/

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Prevention Initial Customer Contact (Local Authority)

Points to Consider · 60-70% of contacts should be resolved at first point of contact, including simple services and simple equipment. Recording of all contacts is an

important part of understanding how to shape local care markets

Individual, carer or family

·

Only complex cases should be passed to qualified staff

· Provide easy access to clear information, advice and guidance to citizens in a delivery format that suits them (Internet, face-to-face, digital TV) · Develop and implement a channel management strategy – don’t assume people will already know how to best access information they need

Council Contact Centre

Online Information Portal

80%

Query resolved or person signposted

· Hampshire County Council Care Choice: http://www3.hants.gov.uk/carechoice.htm ·

Oxfordshire County Council Getting Care

· Kent County Council Advice and Guidance: http://www.kent.gov.uk/adult_social_service s/your_social_services/advice_and_guidance. aspx

· Allow the person to make an informed choice as to why they would approach a local authority, what services they could expect to access and that social care services are means-tested

Consider Avoiding: 20%

Suitable for enablement or eligible for on-going care

Back to Overview

Examples

· Beware of multiple and overlapping contact points – this is expensive and potentially confusing for the customer · Avoid qualified staff taking first-contact calls directly. A small number of qualified staff can support unqualified, highly skilled operators to quickly resolve customer queries · Don’t assume people are dependent and need to enter council systems

Useful Links · Think Local, Act Personal website – Information and Advice: http://www.thinklocalactpersonal.org.uk/Bro wse/Informationandadvice/index.cfm · Think Local, Act Personal website – Selffunders: http://www.thinklocalactpersonal.org.uk/Bro wse/Self-funders/index.cfm

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Supporting Recovery & Maximising Independence Crisis and Rapid Response

Person with severe change in need

Crisis/Rapid Response Service

Discharge to community (home)

Points to Consider

Examples

· This service provides immediate support for people (within their home) who have had a sudden and severe change in need

· Care Services Efficiency Delivery: http://www.csed.dh.gov.uk/CrisisResponse/

· It should consist of a multi-disciplinary team of health and social care staff, accessed through a single entry point · The aim is to prevent a hospital admission, which can increase the likelihood that a frail older person will not return to the community · Recent studies have shown that people funding their own support make decisions at a time of crisis, often in hospital. People described a struggle to obtain appropriate information, advice or advocacy to help them make these decisions (see useful links)

Discharge to enablement service

Consider Avoiding: · Commissioning and designing these services in isolation. They are unlikely to be as successful if Health and the voluntary sectors are not involved (see Useful Links for more information)

Back to Overview

· Avoid assuming that pre-existing intermediate care services include an effective rapid response. Assess productivity levels and ensure they reflect current best practice

Useful Links · People Who Pay for Care: http://www.thinklocalactpersonal.org.uk/Bro wse/Selffunders/index.cfm?parent=8609&child=8647

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Supporting Recovery & Maximising Independence Enablement

Hospital discharge

Rapid response service

Council initial contact

Points to Consider

Examples

·

Should be a core part of a target operating model and the default pathway for anyone with eligible on-going needs

·

·

Other preventative services such as Telecare should either be aligned or included with the enablement service

·

Referrals should be taken from both community and hospital discharge, with clear and consistent referral criteria. Reasons for people not completing enablement services should be documented and used to improve process where possible

Up to 6 week personalised intervention

Consider Avoiding: · No ongoing needs

Eligible for on-going care

Back to Overview

Setting referral points too far back in the operating model (e.g. after care planning). The closer enablement is to assessment, the less potential there is for wasted process

Care Services Efficiency Delivery: http://www.csed.dh.gov.uk/homeCareReable ment/

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Staying in Control of Your Support Allocate Resource

Financial assessment

Needs assessment

Calculate contribution (if any)

Points to Consider

Examples

·

In most cases customers should arrive at this step through the enablement service and all should have eligible on-going needs

· ·

·

Simple ready-reckoner approaches to resource allocation can initially be used, helping people to have access to personal budgets as early as possible

·

·

The indicative allocation amount should be as close as possible to the final approved budget – if it is not then there is a high risk of wasted process (as well as frustrated staff and customers). Adjustment to the RAS may be required

·

Making this step available online can assist people who pay for their own care to understand their needs and potential costs

·

Detailed support planning is not a prerequisite for offering a personal budget – it is sufficient that there is consensus that reasonable resources have been offered to meet eligible assessed need and that a set of outcomes are agreed to guide the use of money. The individual must also understand their obligations if taking a Direct Payment

Calculate indicative budget

Plan for support

Consider Avoiding: · Back to Overview

Waiting for complex resource allocation systems with long development cycles. Experience has shown this leads to less personal budgets issued as staff wait for new systems

Points-based Non-points based and ready reckoner approaches Commercial-off-the-shelf products

Useful Links ·

Think Local, Act Personal website: http://www.thinklocalactpersonal.org.uk/Bro wse/SDSandpersonalbudgets/Resourcealloca tionsystems/index.cfm

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Staying in Control of Your Support Financial Assessment and Benefit Check

Financial Assessment initiated

Contribution calculated

Detail different components of allocation (council funding, contribution)

Review

Back to Overview

Points to Consider

Examples

·

Customers should be aware care services are means tested during the advice and information stage (i.e. as early as possible)

·

·

Financial assessment should be conducted parallel to needs assessment so a person knows how much money is available to them and how much they will need to contribute

LB Sutton - Benefit checks on Tablet PCs: http://www.auditcommission.gov.uk/localgov/goodpractice/pa rtnership/Pages/suttonpcs.aspx

·

LB Hillingdon: http://www.csed.dh.gov.uk/_library/Resourc es/CSED/CSEDProduct/Financial_assessment _Hillingdon_case_study_v.1.pdf

·

There are many software systems available to automate financial assessment and benefit checks which can significantly decrease process time

·

Obtaining access to DWP data (with customer consent) speeds the process and avoids gathering duplicate information – see LB Hillingdon case example

Consider Avoiding: ·

Delaying financial assessment can result in substantial income loss for local authorities

·

Be wary of introducing disincentives to the process. One case study’s process prior to re-engineering demonstrated customers who returned financial re-assessment forms promptly had to pay increased contributions sooner in the financial year than those who delayed returning forms

Useful Links ·

Fairer contributions guidance 2010: calculating an individual's contribution to their personal budget: http://www.dh.gov.uk/en/Publicationsandsta tistics/Publications/PublicationsPolicyAndGui dance/DH_121224

·

Think Local, Act Personal website: http://www.thinklocalactpersonal.org.uk/Bro wse/SDSandpersonalbudgets/contributionsch arging/index.cfm

·

Care Services Efficiency Delivery: http://www.csed.dh.gov.uk/assessmentCare Management/effectiveFinancialAssessment/

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Staying in Control of Your Support On-going Support, Review and Protection

Points to Consider

Examples

·

Easily available guides and tools should allow people to review for themselves whether support is working. Placing these tools online will also allow people who self-fund to take advantage of tools they would not have previously had access to

·

·

In cases where one or two providers are providing services to a customer (for example, through an Individual Service Fund) it may be possible for a trusted provider to help with the review

·

In the points above both the authority and customer will need to sign-off on the review

Individual identifies who will be involved (family, friends, carers etc)

Peer support Vol Orgs / ULO

Council or provider staff

Outcome-focused Reviews: Personal Stories http://www.thinklocalactpersonal.org.uk/_lib rary/Resources/Personalisation/Personalisati on_advice/OutcomeFocusedReviews2.pdf

Review completed

Change in need including safeguarding considerations

Authority and customer sign-off

Back to Overview

Consider Avoiding: ·

Avoid using reviews as an audit tool for services purchased. The aim of a review is to ensure that outcomes in the support plan are being met and that support is working for the individual

Useful Links ·

Think Local, Act Personal website: http://www.thinklocalactpersonal.org.uk/Bro wse/SDSandpersonalbudgets/Review/index.c fm