growing self direction in health together welcome!
Post on 18-Dec-2015
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Growing Self Direction in Health Together
Welcome!
Self Direction in Health and social care-shifting control for better lives-our story
so far......
Overview
• Snapshot background.• What is self directed support and what is its purpose.• Cherishing as well as changing.• Citizenship and Health• Whole people in our whole context- Real “wealth”• Important “to” as well as important “for”:-working
together.• How we can together make useful change happen.
From institution to citizenship
4
In Control’s system of Self Directed Support is based on a clear set of values.
The purpose of our work is to support improved decision making and a better relationship between people and the Welfare State, so that people get better lives. We know that people’s lives don’t split into health and social care. Our support needs to focus on whole people in their whole context with contributions to make as well as needs to be met.
This means: Influencing policy Focusing on practical solutions Being a source of mutual support and An exercise in citizenship
In Control’s purpose
Connecting Innovation by people with Government policy.
Professional gift model• The underlying system of
power: ‘we know best’.• Professionals and
commissioners work out what they think we need.
• They buy things they think will help.
• We have to slot in. • We feel we should be grateful
and stay as passive recipients. • We have not rethought power
Citizenship Model
• Citizen at the centre
• Services negotiated
• Entitlements defined
• Community fully engaged
• Outcomes improved
Times are changing....
“Ensuring older people, people with chronic conditions, disabled people and people with mental health problems have the best possible quality of life
and the equality of independent living is fundamental to a socially just society...
“The time has now come to build on best practice and replace paternalistic, reactive care of variable quality with a mainstream system focused on prevention, early intervention, enablement and high quality personally tailored services. In the future we want people to have maximum choice, control and power over the support services they receive”
(“Putting people First DH 2007)
Cherishing as well as changing
The creation of the NHS was one of the great achievements in the development of the welfare state and we are rightly proud of it.
In Control supports the NHS providing: Highest quality care Universal and equal access Being free to those who need it.
These are important principles and any reform should seek to improve them.
In Control’s approach to personal health budgets:–innovation not imposition
Self Directed Support is a complex well-developed approach specifically designed to reform social care- it works well since it leads to better decision making.
The nature of decision making in health care is different, as is the history, legislative context and number of professionals involved-and we all use
health care.
The ideas underpinning Self Directed Support are increasingly originating within the NHS, perhaps using slightly different words but following the same themes of shifting power and control closer to people
For example the work on “Rethinking long term conditions” by the Centre for Clinical Management Development at Durham University, the “Co-creating Health” three year demonstration programme by the Health Foundation, the “Expert Patient Programme” and the Department of Health “Personal Health Budget pilot programme”.
There is an emerging consensus that it is possible to successfully apply the principles of Self-Directed Support to some parts of the current health care system as well as to social care.
An emerging consensus
Personal health budget-what is it?The person must: Know how much money they have in their personal budget Be able to spend the money in ways and at times that make
sense to them Agree the outcomes that must be achieved with the money
Personal health budget-ways to “hold” the money
Personal Budgets can be held in a range of different ways: including a real budget held by a third party, or (when legislation is in place) healthcare direct payments. (As outlined in section 3.6. pages 32 to 35 of “Personal health Budgets First
Steps” document- DH 2009)What is important is that the person knows
how much money is available with which to plan and that they can decide flexibly how to meet agreed outcomes.
Budgets alone won’t work
Our experience suggests that while personal health budgets may be very useful- they will only work if there are also:
Opportunities to meaningfully plan and shape treatment and support- flexibly
Effective systems of support, information and advice
A range of effective options Appropriate systems for professional input and
monitoring. A shift in the power between an individual and the
NHS
How does citizenship impact on Health?
Citizenship in HealthOur health is influenced by many more things than
good health care. It is impacted by:PovertyIsolationUnemploymentPoor housing etc..
A society that excludes people from citizenship guarantees poor health e.g.-look at the early death rates of people with mental health problems...
Purpose: active citizenship and healthy communities-not simply consumerism. The purpose of Self Directed Support is to enable improved
decision making and a better relationship between people and the Welfare State, so that people get better lives, as active and included citizens, part of healthy communities.
It is not simply about giving people money; sometimes people are most impoverished when they are using their own money since they have no information, no connections, no confidence, no knowledge of other possibilities and no one to help them plan.
We know that people’s lives don’t split into health and social care. Our support needs to focus on whole people in their whole context with contributions to make as well as needs to be met.
For people to have control of the necessary resources for active citizenship we need to see people as whole people in their whole context- their “real wealth”-not only their illness and finances.
This includes increasing people’s understanding of risks, options and good strategies
Strengthening people’s skills and confidence
Helping people to stay connected to each other.
Real “Wealth”
Times are changing
Traditional interactions Belief that knowledge
creates behaviour change Goals are set by the
clinician and success is measured by compliance with them
Decisions are made by the clinician.
Collaborative interactionsBelief that one’s confidence
in the ability to change, together with knowledge, leads to behaviour change
Person is supported in defining their own goals. Success is measured by attaining those goals
Decisions are made as a patient-clinician partnership
Power with clinicians Co-production-power shared
Tilting the balance of power
Its about shifting power and creating an improved relationship
Central focus is improving the dialogue between the citizen and the professional to create:Greater mutual respect & understandingBetter quality decision-makingBetter outcomes
This should produce a Personal Plan which is co-signed by the citizen and professional
Cherishing as well as changing
Whilst we shift our focus towards outcomes and keeping processes around personal health budgets as simple as possible, we must also sustain current good practice. Thus we must ensure we have:
A clear process for authorising plans, Expert clinical input alongside an individual’s
own views and ideas, Continuous appropriate monitoring and review of
some-one’s health condition over time.
Next steps-Staying in Control Phase Two
• In Control’s second phase of work focussing on how self directed support can work best in Health currently has 26 members who will be working collaboratively throughout 2010.
• Our work will complement the Department of Health’s personal health budget pilot research.
• Our approach is to learn by doing- with small steps with real people in real life.
• Finding creative solutions together , sharing those and evaluating differences from person, family and professionals’ perspectives.
• Optimistic and pragmatic, enthusiastic and grounded
Our Health members 2010• Lincolnshire • Stoke on Trent • Norfolk • Nottingham City • Hull • Stockton on tees • Hartlepool • Eastern and Coastal Kent • Nottinghamshire • Bassetlaw • Redcar and Cleveland • Warwickshire • Northamptonshire
• Northumberland • Shropshire • Blackburn with Darwen • Central and Eastern Cheshire • Halton and St Helen’s • Warrington • Western Cheshire • Cumbria• Ashton, Leigh and Wigan and• North West Strategic Health
Authority• West Midlands SHA• Solihull • Heart of Birmingham
Department of Health Personal Health Budget Pilot Research Sites
Hartlepool PCT with Stockton PCT• Doncaster PCT Hull Teaching PCT• Manchester PCT• Merseyside (joint bid) Stoke on Trent PCT• Health and Wellbeing Partnership• (Birmingham)• Barking and Dagenham PCT• Havering PCT• West London (joint bid)
Norfolk PCT• Oxfordshire PCT Nottingham City PCT Northamptonshire Teaching PCT• Avon, Gloucestershire, Wiltshire• and Somerset Cardiac and Stroke• Network• Bedfordshire PCT Eastern and Coastal Kent PCT• Medway PCT• Torbay Care Trust• Dorset PCT
Some Key issues:-
People themselves have the highest vested interest in getting best value for money.
Self Directed Support and personal health budgets are not a universal panacea- they will not be appropriate across the whole of the NHS, nor will they resolve the financial constraints of a limited budget.
What self directed support can do is enable an open debate about health priorities and how to connect provision of resources to need, in the most efficient and effective ways.
Self directed support can be seen to transform lives. It will be essential to evaluate changes in people’s lives, from
the perspective of individuals, family carers and professionals.
Whole people changing whole systems...
It’s early days and there’s much to be considered but people’s lives can’t wait...
Self Direction in Health-working together to create useful change.
How?Thinking about how a personal health
budget can be held and managed
Figure 6: Approaches to holding a personal health budget. (Source, Dawn Stobbs, DH)
Continuum of Control:Third party ‘mechanisms’ and their locus of
control
• An Independent User Trust
• A community Interest Company
• User-led Organisation
• Voluntary Organisation
• Private Sector
An Independent User Trust(also known as an Independent Living Trust)
• Puts the individual at the heart of decision-making
• Friends, family members, advocates or others can be trustees
• The trust follows the rules set out in the trust deed and can employ staff
• However, not everyone has an established circle of support and trustees may see the responsibility as too onerous
A community interest company(a type of social enterprise)
• They are quite easy to arrange and are not-for-profit
• Families could join together to set up their own CIC
• However, a CIC that operates as an ‘agency’ for more than one person may need to be CQC registered and the individual focus will be lost.
User-led Organisation
• All local authorities are required to support the development of a user-led organisation in their area.
• The locus of control lies with citizens
• However, they may have a wide remit and lots of clients
Voluntary Organisation
• Good source of advice, information and support
• Good networks and more community-based
• Not-for-profit
• However, the budget holders voice may be weaker than with other arrangements i.e. independent user trust
• The organisation may have a wide remit with many clients and may be quite bureaucratic
Private Sector
• Commercial drive
• Service development
• CQC registration
• However, the budget holders voice may be weakened.
• There is a profit motive
“Managing the money: Resource Development Options for Personal Budgets”
(CSIP)•Three guiding Principles:
• Self-determination: Decision-making should be as close to the individual as possible remembering that involving people is not the same as sharing power
• Transparency: Not only should the individual know the resources available to them for planning, they should have easy access to detailed income and expenditure
• Choice and control: Third party arrangements should promote citizenship. They should be flexible and should focus on outcomes.