way ahead – north lanarkshire report

8/14/2019 Way Ahead North Lanarkshire Report

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Way Ahead

AUTHORS: KEITH ETHERINGTON,

PROF CHRIS HATTON and JOHN WATERS

Our early experience in North Lanarkshire

of demonstrating the impact of thein Control approach JUNE 2009


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Cover Picture:Big Heids by David Mach on the M8 in North Lanarkshire


3/16 North Lanarkshire Council | In Control Scotland 1

Early In Control experience in North Lanarkshire

Foreword

In North Lanarkshire, our aim is

that people may exercise maximum

choice and control over their lives,

including control over any support

they may require. We take great

pride in our eorts to lead the drive towards

ever more personalised approaches. Indeed we

have already individualised the planning, design,

service delivery and unding or over a thousand

people across North Lanarkshire. But, until now,

we have rarely been clear with each person and

upront about the fnancial resources available to

meet their needs. By not doing this we have not

maximised the extent to which each person cantruly exercise choice and control.

The In Control demonstration project tested outan approach that supported people to undertake

their own assessment o need, leading to anancial value that we believed was reasonable

to meet their needs; we then invited each personto make best use o those resources in ways that

suited their own unique needs and circumstances.

The small numbers o people in the demonstrationproject seized this opportunity in highly innovative

and exciting ways. We have much to learn romtheir experience and must now apply this learning

to improve the lives o many more people in NorthLanarkshire.

We believe passionately that people shouldnot be denied opportunities because o their

age or the nature o their disability or needs, sothe people involved in the project had a wide

range o needs and circumstances arising romautism, railty, dementia, long term neurological

conditions, mental health problems, alcoholrelated brain damage and learning disabilities.

Their ages ranged rom 9 to 98 years.

I would like to thank all the people and theiramilies who were involved as well as the sta

in Younger Adults and Finance Sections within

Social Work services and Keith Etherington ortheir leadership in this important work. Thetestimonies o the people concerned are very

powerul endorsements o the approach taken.As one carer said being in receipt o In Control

money has given us a lie again.

The challenge now is to make their experiencea reality or everyone.

Duncan Mackay

Head o Social Work Development

North Lanarkshire Council

Way AheadOur early experience in North Lanarkshire of demonstratingthe impact of the in Control approach


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Introduction

In April 2008 North Lanarkshire Council Social

Work services launched a demonstration project

designed to explore an exciting innovation in social

support and/or care arrangements for individuals.The ideas being tested involved allocating people

who need social care support their own individual

budget with which they and their families could

design and implement their own unique support

package. The intention of this approach was to

offer greater choice and control to participants

and their families over the support on offer and

to ensure it was tailored to their unique wishes

and aspirations. As a result of this demonstration

project 16 people, together with their families,

took control of an individual budget.

Whilst at its heart this is a simple idea, the

approach represents a radical departure rom ournormal arrangements or providing help to local

people, and presented a signicant challenge.We needed to design a way o saying to people

how much money each person should haveavailable in their individual budget. The amount

o money needed to refect their level o need andtheir social circumstances as well, o course, also

needing to be realistic and aordable to the local

authority in the longer term.

To appreciate the signicance o this simple but

radical innovation it is important to considerhow the current system works. Despite our

attempts to personalise our services, peoplein North Lanarkshire who are believed to be

entitled to support are generally subject to aproessional assessment process. Following on

rom this, i they are seen to be eligible or helpand assistance, they would generally be allocated

support arrangements rom one o a number

o Council services, allocated support rom an

approved service provider, or in some instances,receive a direct payment to buy hours o support.

These approaches oten struggle to meet thedivergent needs, and wishes o large numbers o

service users. This traditional care management

approach has been criticised as being outdatedand in need o reorm or a number o reasons.

" People with disabilities are passiverecipients o support

" There is a lack o transparency aboutentitlement

" There is little incentive or amily riendsto contribute

" Services oten struggle to respond fexiblyenough to individual needs

"

Individuals are slotted into an existingservice

The Executive Summary o the document

Changing Lives: Report o the 21st CenturySocial Work Review in Scotland recognised that

continuing to provide support and services intraditional ways is neither easible nor desirable:

Doing more o the same wont work. Increasing

demand, greater complexity and rising expectations

mean that the current situation is not sustainable;

tomorrows solutions will need to engage people asactive participants, delivering accessible, responsive

services o the highest quality and promoting

wellbeing.

The RAS takes the orm o a simple supportedsel-assessment questionnaire that is used to

let people know early on in the process howmuch money is available to them rom the

local authority to und their support. It alsoclearly states the intended outcomes o their

support plan. The RAS gives an indication o

the maximum amount o money that shouldbe in a persons individual budget and what itmust achieve.

An individual budget is the money made

available to a person or them to use to develop

a support plan. The money can be held by the

person themselves, by their representative, or

by the local authority. The important thing is

that the person and those close to them have

control o the money. Knowing how much

money is available and what outcomes must

be achieved, the person and their amily can

take control o their individual budget and plan

how it is used. Once the person, or those closest

to them, have developed a plan, the local

authority is then asked to approve the plan and

arrange or the money to be used as agreed.

This important check provides a mechanismthrough which the authority is able to meet its

wider social and nancial responsibilities.

A Resource Allocation System (RAS)

The individual budget




We wanted to test whether we could improve onthe traditional way o working and establish a

more person centred and fexible approach - onebased on a greater partnership and transparencybetween the Council, its social work sta, people

and their amilies. This meant we needed a way ogenuinely sharing decision making. By creating

a simple ramework to allocate resources, weestablished or each individual and their amily a

ring enced pot o resources we gave them theirown individual budget. We were then ree to help

them plan how these resources should used toachieve a set o agreed outcomes.

The In Control approach to organising social care

has come to be known as self directed support,

and is based upon a 7 step process.

1) Money people are told how much money they

can have in their individual budget and what themoney must be used to achieve. I people are to

direct their own support it is important to be clearearly on how much money is available to use in a

support plan and the outcomes it must be usedto achieve. To do this the local authority must

develop a resource allocation system (oten knownas a RAS).

2) Making a support plan people who have anindividual budget, plan how to spend the money.I people are to have support that is personal to

them there needs to be a good plan describingwhat it needs to achieve and what it will look

like. The things that the plan needs to achievemust be agreed by the individual/amily and the

social worker, but it is important that the personand those close to them lead on how this is to be

achieved. Some people, but not all, have help roma social worker to produce a plan.

3) Agreeing the plan. As the local authority is

making money available to und the support planit is reasonable that they will want to agree how

that money is used. The local authority also needsto ensure they are happy with any risks the person

may be choosing to take.

4) Organising money. Once the money and theplan are agreed the person needs to be in control

o the money so they can direct their support.There are dierent ways this can be achieved.

Taking the money as a direct payment is not rightor everyone, so other ways o being in control o

how the money achieves what is important to theperson need to be available.

5) Organising the support. Now that the budget

is under the control o the person, they canarrange or the support to be delivered. This

can involve such things as buying equipment,negotiating with a provider how, when and what

support needs to be provided; and how peopleare involved in recruiting sta.

6) Living life. When people are supported in waysand at times that are right or them it is possibleto live a ull and active lie.

7) Seeing how it worked. It is important to

take time to look at how well the plan hasworked and to show what the money has been

used to achieve.

Importantly, as a Council, this work has allowed

us to test the application o a resource allocationsystem so that we may consider such an approach

on a whole system basis. Critics o In Control say

the use o a resource allocation system is simply a

way o gate keeping fnite budgets. But any social

care system requires us to do just that, and most

are so opaque as to be impenetrable to people who

may need support. This approach, in contrast, was

transparent.

Duncan MackayHead o Social Work Development

North Lanarkshire Council

It is widely acknowledged that a lot o theearly work and thinking around in Control and

sel directed support has its origins in Scotlandand, in particular, in North Lanarkshire,emerging rom the work and thinking that

developed during the closure o long stayhospitals or people with a learning disability.

Since the early part o this decade, seldirected support and individual budgets have

been urther rened and eature strongly inthe reorm o social care underway in England.

The demonstration work in North Lanarkshirehas drawn heavily rom some o the learning

and resources that have emerged rom this.

Origins of in Control and self directedsupport:




How we set aboutimplementing the in Controldemonstration work

The plan for the in Control demonstration projectwas that up to 20 people in the area would be

supported to follow the In control approach and

system of self directed support.

The project team identied to take a lead on

implementing the demonstration work waslocated in the Younger Adults Section within the

Motherwell Headquarters o Housing and SocialWork Services in North Lanarkshire Council.

The team comprised the Manager o the Younger

Adults section; A Service Manager and SeniorOcer rom the section; a representative rom

Social Work Finance; a Social Work Assistantwho provided the organisational support and

an independent consultant who worked in thesection part-time during the demonstration

work. This group initially met ortnightly toreview the progress o the demonstration work;

discuss the indicative allocations o resources thatwere identied through using the supported sel

assessment questionnaire; and agree the costed

support plans that were completed.

Who was includedWe knew that the work would be o great interestand hopeully lead to positive outcomes so we

needed to be clear who could be involved. Wedecided that the two priorities or being included

in the demonstration work would be:

" people who did not have an existing serviceand who were not having their support

needs met" people where there was pressure or change

in their existing support, (or whateverreason)

We also wanted to make sure the learning was

spread widely across the council so we includedpeople rom across the 6 dierent Social Work

Localities o North Lanarkshire:

" Airdrie" Bellshill

" Coatbridge" Cumbernauld

" Motherwell" Wishaw

It was also decided to include people o allages (rom young children to older adults) with

dierent reasons or needing additional support.

It was elt that this approach would provide the

broadest opportunities or learning as well asensuring that workers and amilies rom the

whole o the authority had some experience inusing sel directed support. We also wanted to

test whether the system o sel directed supportcould produce positive outcomes across a broad

range o ages and needs. We knew we wouldbe learning as we took the work orward so a

Learning and Development group was establishedto provide eedback on progress and share and

develop ideas throughout the period o thedemonstration work.

How people came to be involvedWe asked workers in each o the locality teams toreer people to the project, who met the criteria

and who they thought might want to be involved.Workers were asked to ensure that anyone

they put orward already had an up to datecommunity care assessment. All reerrals were

processed through a Senior Ocer in the YoungerAdults team in the Social Work Headquarters in

Motherwell and discussed at a project meeting.

This meeting was used as the way o ensuringthat the broad spread described above was

achieved. In act, the age range o those whowere involved in the demonstration work over the

year was between 9 to 98 years.

How people got goingOnce it was decided that a amily or individual

should be included in the demonstration work,an initial meeting was arranged with them, their

social worker and someone rom the project teamto discuss sel directed support and to help them

to complete a sel assessment questionnaire. Theanswers rom this questionnaire were entered

into our Resource Allocation System (RAS) togenerate an indicative allocation o resources. This

became the amount o money that the personor amily could use to develop their support plan.

Because the RAS had not been used beore, theindicative allocation was discussed in the project

team to test out i it was elt reasonable andappropriate beore it was shared with individuals

and amilies.

Both the supported sel assessment questionnaireand the RAS were adapted and rened over the




year as more experience was gained in theiruse. In particular, the questions in the supported

sel assessment questionnaire were rened togive a wider and more dierentiated spread and

adjusted to increase the scoring or people whoneeded signicant support in personal care tasks.

Support planningThe support planning took longer or some peoplethan others - some people developed a simple

plan with relatively little help very quickly, whilstothers took several weeks or even months to

develop a plan with substantial support romtheir social worker. Almost everyone asked some

questions about what they could spend theirmoney on. The answer was anything, as long

as it helps you meet the outcomes identied in

your support plan and is legal. This was a veryempowering statement that made it possibleor people to think dierently and plan more

creatively. Resources to help the support planningwere gathered rom a range o sources including

the In Control website (www.in-control.org.uk).A simple review process was also established to

take place, initially ater the person had been incontrol o their individual budget or 3 months. In

the review, we ocussed on what had worked well,what needed to change and what i anything the

person was concerned about, as well as ensuringthat the money was being accounted or correctly.

The help people had to organise theirsupportDuring the course o the demonstration work,

North Lanarkshire Council invested in creating

additional time limited capacity in a national

resource, the Scottish Personal Assistant Employers

Network (SPAEN), located in Motherwell in the

North Lanarkshire area. This ensured people

could access support, guidance and training i

they wished to take on the role o employer o apersonal assistant. Although not everyone chose

to employ personal assistants, the majority o

those involved in the demonstration work did

choose to take at least part o their allocation as

a direct payment o money. This may have been

particularly pronounced because o the criteria or

those chosen to be included in the demonstration

work.

How people spent their individual budgetsPeople who were involved in the in Controldemonstration work in North Lanarkshire spent

their individual budgets in a wide variety o ways.Most people took at least some o their budget

as a direct payment that they or a amily memberthen managed directly, and almost everyone

used some o their money to employ one or morepersonal assistants.

This is only part o the way in which people

themselves made decisions and choices on thebest way to spend their money

For example,

" Vicky, the very rst person to receive an

individual budget in the area, spent some o

her money on installing an air conditioning

unit in her bedroom to help to keep hersel as

comortable as possible in the hot weather;

some money on accessing an Open University

course as she had missed out on chancesto learn, and some money on massage and

refexology all linked to helping to alleviate

her long term health condition

" Michael spent some o his money on

support to attend the college o his choice,as well as having lessons to help him learn

to play the bagpipes, and getting supportto keep t all things that he enjoyed and

North Lanarkshire Council received a smallamount o unding rom the Scottish

government through the Changing Livesprogramme to create some additional capacity

to carry out, support and evaluate the inControl demonstration work over the year.

Funding for the demonstration work

IN TUNE AND IN CONTROL




where he was able to be successul as a

young man with additional support needs

on the autistic spectrum

" Marc spent some money to help plan a

holiday away with his amily - instead o

having to go away rom his amily to get abreak.

All o this was done by individuals and amilies

making choices about how they could best use

their individual budget to have the most impact

in their lives.

What Monica said about

her experience of havingan individual budget

I am a young woman with a serious illness

that restricts my physical and mental health.

Thereore I had been unable to nd a package

o care that meets my specic needs. My mum

has been my only support until now and I stay

with her. Mum works ull time as a proessional

in a school, and I have stretched her to the limit

contacting her during working hours. As soon as

she arrives home, I am waiting or her or total

time and attention to meet my emotional and

physical needs.

In Control has transormed my lie, in many

ways opening up a new way o thinking or

the uture. What makes In Control dierent

rom other support packages is the fexibility

it allows me on a daily basis. With my personal

assistant, I am able to access the communityand venues o my choice: cinema, eating out,

short breaks away, etc. (when I eel able). I am

in control or the rst time and do not eel

guilty about not tting into the ideas and plans

that others have made or me.

Many thanks to everyone who has been

involved in helping mysel and mum through

the process o In Control, especially to Caroline,

my Social Worker. Caroline has taken me

orward to a new lie experience away rom theisolation o being conned to the house. This

has allowed me dignity, respect or mysel and a

better quality o lie.

What having anindividual budget meantto Susan

Susan lives at home with her husband and wasdiagnosed with multiple sclerosis some 16 years

ago. She gave up work 4 years ago and had beennding it increasingly dicult at home, especially

when her husband was at work, due to dicultywith her balance and her increased atigue.

At rst, Susan and her husband applied or adirect payment under the existing scheme in thearea, but when they heard about the In Control

demonstration work, they were attracted to theincreased fexibility this would bring. Susan was

one o the rst people in North Lanarkshire toget an individual budget and has been using this

or about 9 months now. The money goes intoa separate account they have opened or this

purpose every our weeks. Susan spends some othe budget on employing a personal assistant to

help her. She was able to employ someone whoshe already knew who lives locally and can work

fexibly. Money to pay the personal assistantssalary and tax etc goes out o her account as a

direct debit to an organisation that deals with thepayroll.

Refecting on her experience o sel directed

support Susan commented I eel much saer athome now, having someone there to help and

support me

As well as employing an assistant Susan bought asmall electric wheelchair to help her move around

the house more easily which she adapted urtherto make it easier to control. She also spends some




o her money on extra physiotherapy in her ownhome and to help her get to a local resource,

where she can meet people and gets the chanceto enjoy other therapies, including yoga andaromatherapy.

Recently Susan went into Hospital to have her

medication reviewed. The stay in Hospital waslonger than had been anticipated at rst, but

during this time Susans personal assistant wasable to change the hours she worked so she was

around at weekends when Susan was at home.Since Susan was ully discharged rom Hospital

she has made changes in how she uses herbudget. She has increased the hours o support

she buys each week rom her personal assistantwhilst still keeping within her overall allocation.

Being able to use her budget in this way and makechanges has been important to Susan and her

amily and has given them greater choice, controland peace o mind.

Susan eels My plan is working very well and Iam enjoying the fexibility o it and being able to

decide when and what I want.

What having a individualbudget meant to John

John is 14 and is a young man with Downs

syndrome who lives at home with his mum anddad. He has two older sisters who both now live

abroad. He goes to a local school but has ound itharder as he has got older to get to keep contact

with riends outside school. He wanted the chanceto be able to try some new things as well as get

out more with people around his age, to enjoymore o things he likes to do.

Johns amily had also begun to plan about how

they might all get a break and had been thinkingabout John going to stay with another amily or

a holiday. They considered applying or a directpayment under the old system, but elt there may

be too many restrictions around this, so were veryinterested when we talked to them about being

involved in the In Control demonstration work inthe area. Ater nding out how much money wasavailable to John in his individual budget, John, his

mum and dad developed a support plan. The rstthing they did was to recruit a 6th orm student

rom Johns school as a personal assistant, to sharein, and support him to take part in some social

events and activities, mainly at weekends. So ar,they have been to music events, sport activity and

on a lm making course together. John has alsoused some o his money or skiing lessons and

or drumming tuition so he can be part o a localdrumming band.

Johns dad said It has been great or John havingthe fexibility and independence to try new things

with support available.

Next year, Johns personal assistant will be going

o to University, but as its still local, she thinksshe will still be able to support him in this way.

Johns mum manages the money and his personalassistant is paid through a local payroll rm who

deal with her salary.

John has been using an individual budget or

about 6 months now. His big adventure is thatlater in the summer he will be going on a trip toNew Zealand without his mum and dad to see his

sisters and young nephew. He plans to pay theare o a amily riend who will take him over and

come back with him.

John said I miss my sisters, but going out to town

with my support worker is good too.

What Rosemary (who is afamily carer) said havingan individual budgetmeant to herThe payments rom the In Control programme

have completely transormed not only my lie butalso my mothers lie. I am a ull time carer or my

mother, who will be 90 later this year. In June Iwill be sixty. We were really struggling nancially.

Over 10 years ago, I had to take early retirementon the grounds o ill health and my pension was

reduced considerably. The Carers Allowance asall carers will know is a sick joke. Since I have no




brothers or sisters, and no relatives who are willingto help with the care o my mother, the entire job

o looking ater her ell to me. She is a really livelyperson but the strain o caring or her twenty ourhours a day was beginning to get to me. I used

quite a lot o my pension money to buy in helprom people.

Luckily, when I had practically reached the end o

my tether, North Lanarkshire included me on theirIn Control pilot scheme.

Now we have money to pay or care or my mother

in her own home so that I can have a break ortwelve hours a week.

However, the best part is that we can now do what

my mother loves best in the whole world gotravelling.

We dont go to ar fung corners o the earth but

we are able to take little trips to Scotland, Englandand Ireland. Last autumn we were able to rent

a cottage in Shropshire and my cousin and herdaughter came and stayed with us. These were

people my mother hadnt seen or years. For herbirthday, we booked an extra special ew days in

Aviemore and somebody else did the cooking ora change. Later this month, were o to Tiree or a

week. Holidays make my mother come alive. Herdementia never seems so bad and she has things

to talk about and to tell other people. Being inreceipt o In Control money has given us a

lie again.

The evaluation process

The evaluation of the demonstration project

was carried out by Prof Chris Hatton from the

University of Lancaster and John Waters from In

Control in England.

The evaluation included contributions rom arange o relevant stakeholders including:

" people who were allocated individual

budgets

" their amilies

" Care managers and rontline Social Worksta

" Social Work managers

The evaluation was undertaken in two parts.

The rst part involved gathering inormationusing structured interviews and evaluation

questionnaires and took place in early April

2009. Separate questionnaires were completed

by people in receipt o an individual budget;their amilies and/or carers, and rontline Local

authority sta who had been involved with atleast one person in the demonstration work.

The second part involved holding A Sharedlearning event at the end o April 2009, whereaggregated inormation gathered in part 1

was shared with a wide range o people and itsimplications considered. This part included all the

our stake holder groups identied above.

Part 1: Inormation gathering

Inormation was collected rom each o the

three stake holder groups using a standardquestionnaire, designed to measure the eect that

having an individual budget had on that group.An independent researcher helped people to

complete these questionnaires. Using a simple 3point scale o:

" Helped

" Made No Dierence" Made things worse

the questionnaires asked people to judge whether

having a individual budget had aected a numbero areas o lie. The questionnaires used had

previously been employed in evaluations o similarwork in 3 other local authorities in the United

TRANQUIL IN TIREE




Kingdom - Cambridgeshire, Worcestershire, andHertordshire - meaning the data produced could

be compared with ndings rom elsewhere. Thiswas particularly helpul given the modest size othe samples involved. At the point at which the

questionnaires were completed, only people whohad been in receipt o their individual budget or

at least three months were asked to complete aquestionnaire. The numbers involved were urther

reduced, as two o the people included in thedemonstration work had very sadly died during

the year.

People using individual budgetsQuestionnaires were returned rom seven peoplewho had been using individual budgets in North

Lanarkshire or 3-9 months. There were almostequal numbers o men and women, and the group

o people was diverse in their needs as identiedby North Lanarkshire.

How people used their individual budgetPeople had used their individual budgets or a

wide range o purposes:

" People to help (Support worker,

employment o live-in carer, personalassistants)

" Cleaning and laundry" Holidays

" Equipment (e.g. computer, ipod)" Transport (Travel to/rom college, taxis,

electric scooter)" Education (Courses e.g. lm making)

" Access to leisure (Museums, exhibitions,cinema, music, entertainment, clubs,

shopping)" Improving health (Gym membership,

acupuncture, physio at home)" Social lie and seeing riends

No person using individual budgets in North

Lanarkshire reported a negative impact o theirindividual budget on any area o their lie. In most

areas o lie, people reported highly encouraginglevels o positive impact that are similar to

inormation collected rom almost 50 adults intwo English counties.

However, individual budgets in North Lanarkshirehad so ar had less impact in the areas o

neighbourhood, paid work, volunteering andhelping the community compared to the workcompleted in England.

The questionnaires allowed individual budget

recipients to provide comments these included:

" Delighted with arrangement

" What would be helpul would be training

or assistance with the nancial recordsneeded

" Happier because [I] can depend on an [the]amount o money.

" A very good thing, best thing Ive ever had.

Family carers o people using individualbudgetsQuestionnaires were returned rom eightamily carers o people who had been using an

individual budget in North Lanarkshire. Familycarers reported that hal o the people using

an individual budget had been using them orless than 6 months and the other hal between

6 months and 1 year. People using individualbudgets had diverse needs, and most had not

used paid support rom social services beoretheir individual budget. Family carers were

Stake Holder Group Respondents

Individual budget recipients 7

Family members 8

Social workers 10 INDIVIDUAL BUDGETS HELPED ALMOST EVERYONE WITH

INDIVIDUAL BUDGETS HELPED SOME PEOPLE WITH

0

20

40

60

80

100

Money

Weekdays

Weekends

Relationships

withfamily

Mentalhealth

Controlover

yourlife

Whosupports

you

controlsup

sociallife

Percentage

ofpeople

N. Lanarks IB helped Cambs & Worcs IB helped

0

20

40

60

80

100

Home

Wh

oyoulive

with

Evenings

Holidays

Relationships

withfriends

Phys

icalhealth

safehome

safeout

dignity

Percentage

ofpeople





diverse in age and gender and almost all wereliving with the person using a individual budget

and were involved in a caring role or over 20hours per week. All but one o the amily carersreported eeling that they were very much an

equal partner in developing the personssupport plan.

No amily carer in North Lanarkshire reporteda negative impact o their amily members

individual budget on any area o their lie. In mostareas o lie, amily carers in North Lanarkshire

report highly encouraging levels o positive impactthat compare very avourably to inormation

collected rom over50

amily members in threeEnglish counties.

" We need to monitor the extra burden o

paperwork and bureaucracy careully. Needexplicit and clear guidelines on appropriate

expenditure." Still issue about not being able to employ

immediate amily members.

" Freed time and increased quality time.

" I can go out more meet riends. My lie ismuch improved.

" It has been a long, hard struggle to getto this stage. I am so relieved to have this

money it has made my lie so much easiernancially and emotionally.

Sta working with people using individualbudgetsQuestionnaires were returned rom 10 Social Worksta, all o whom had been involved in supportingpeople develop their individual budgets in North

Lanarkshire.

0

20

40

60

80

100

Percentage

ofpeople


A B C D E F G H

ALMOST ALL SOCIAL WORKERS SAY THAT INDIVIDUALBUDGETS HELP WITH

SOME SOCIAL WORKERS SAY THAT INDIVIDUAL BUDGETSHELP WITH

0

20

40

60

80

100

Using your own skillsand knowledge

Allocating resourcesfairly

Managing Risks Staying motivated inyour own work

Percentage

ofpeo

ple


0

20

40

60

80

100

Percentage

ofcarers

N. Lanarks IB impact Cambs, Worcs. Herts IB impact

Continue

caringQual ity of li fe Wellbeing Soc ia l lif e Other

relationships

Choice and

control

INDIVIDUAL BUDGETS HELPED ALMOST ALL CARERS WITH

INDIVIDUAL BUDGETS HELPED SOME CARERS WITH

0

20

40

60

80

100

Finances Paid work Relationship with person

N. Lanarks IB impact Cambs, Worcs. Herts IB impact

Percentage

ofcarers

KEY:AMaking a positive dierence to peoples lives; B Helping people plan creatively;

C Getting the right amount o help to people; D Getting help to people in a timely

way (when they want it); E Helping people to maintain existing support networks;

F Supporting people to take an active part in their community; G Supporting people

to take control and make choices about their lives; H Developing support that is

tailored to the needs o an individual.

One Social Work sta in North Lanarkshire reported

a negative impact o the individual budget process

on one aspect, that o allocating resources airly. Inmost aspects, Social Work sta in North Lanarkshire

report highly encouraging levels o positive impact

that compare very avorably to inormation

collected rom almost 20 community team

members in two English counties.

Confdence levelsThe questionnaire completed by Social Work staalso asked responders to comment upon their

condence level in various aspects o the role theycarried out when helping people take control o a

individual budget. At least 7 out o10 Social Worksta reported that they elt condent in all the

aspects o the individual budgetprocess we asked about.




Social Work sta were asked to comment on their

experience o sel directed support responsesincluded:

" In some way there was more responsibility

on the service user to nd and set up services,so may be there was some reduction in my

workload. However as this was the rst timeI had used an In Control model I worked at

every step with the service user.

" Individual budgets are an added workload.

" It has made me think dierently abouthow people can use allocated unds to live

their lives with support that is valued andinclusive.

" It has allowed amilies to design support

or children in a way which suits all amilymembers. It allows or thinking out o thebox and making supports individual to each

amily. It also makes amilies accountable ortheir supports and spending o monies or

the child thus shiting the control.

Social Work sta were asked to identiy areasin which individual budget would mean they

needed improved knowledge or skills three themesemerged:

" Resource allocation and nancial

monitoring" Monitoring how budgets are used

" Thinking creatively about options or support

When asked about the wider social care systemand i it needed to change Social Work sta

identied our common areas or change:

" To be more localised." To become simpler and aster.

" More resources to allow social workers tospend time with people using individual

budgets." More clarity about the process.

Part 2: Shared learning event

Part 2 o the evaluation took the orm o ashared learning event held in Motherwell on

28th April 2009. The purpose o the event was

to allow a range o stake holders to considerthe collective experiences o people involved in

taking orward sel directed support in NorthLanarkshire. Participants at the learning event

were given inormation rom the rst part o theevaluation and took part in one o three separate

seminars or dierent stake holder groups,ollowing which all participants worked together

to identiy key themes issues emerging rom theirpersonal experience o sel directed support, the

aggregated evaluation data, and the seminardiscussions.

Participants at the learning event included:

" Local people who had an active personal

interest in social care this included peoplewho needed support and their amily

members. Many o this group had directexperience o individual budgets, or were

about to take up a individual budget.

" Social work sta who had worked to

support people directly with individual

budgets." Managers and other senior sta with

strategic responsibility

Summary / Key Messages romthe Shared Learning Event

Beore talking about what people said at the

event, it is important to note the commitmentand spirit with which people engaged at the

event. First, peoples commitment to discussingindividual budgets was shown by the act that

the event was ully subscribed, with many peoplewho had intended to attend only the morning

staying all day. Second, the event included peopleusing individual budgets with very dierent

needs and in very dierent circumstances, amilymembers, practitioners who had helped people

use individual budgets and a range o managerswho had been involved in the demonstration

project. These dierent groups o people workedtogether in a spirit o mutual respect, with a

shared aim across everyone o working together tounderstand how individual budgets were working

in North Lanarkshire and how they could be madeto work better.

Not at a ll conf ident Not very conf ident Confident Very conf ident

0

2

4

6

8

10

Offering support

to complete

self-assessment

questionnaire

Helping develop

person-centred

plans

Advising on

self-directedsupport &

personal budgets

Helping peoplereview their

support

Helping people

organise & arrange

support

SOCIAL WORKERS CONFIDENCE




Although people at the event discussed issues

in relatively small groups, beore sharing theirthoughts with everyone, what they said was highly

consistent and thereore ormed key messages,so we will simply report these key messages here

collectively rather than rom each specic group.

How are individual budgets working inNorth Lanarkshire?Individual budget holders, amily members,practitioners and managers were all very positive

about the impact o individual budgets in theNorth Lanarkshire demonstration project. Positive

themes consistently mentioned included:

" The fexibility o individual budgets, allowingor spontaneity, creativity and developing

imaginative ways to support people." Individual budgets allowed much more controland fexibility about who was employed to

support the person holding the budget, in

ways that tted peoples lives much better and

reduced anxieties or amily members.

" Individual budgets were really useul orlling in the gaps that were not provided

or unded through other sources, such asphysiotherapy, gym membership etc.

" In Controls approach oered more choiceand control or the individual budget holder,

with the balance o power shiting away romservices towards the person and their amily.

" Using the supported sel assessmentquestionnaire and the RAS oered a

consistent way o working out exactly howmuch the budget was, and what outcomes

people wanted to ocus on." Using the RAS was simpler and quicker than

existing ways o agreeing levels o serviceneeded.

" The In Control process meant thatpractitioners spent more time getting to

know people and their amilies and developingmutual trust, rather than making assumptions

about what the person must need." The In Control demonstration project received

strong support in North Lanarkshire, including

highly valued support and advice rom keyindividuals.

" The positive impact oIn Control spread morewidely than the individual budget holder to

the whole amily around the person.

People with support needs, amily members,practitioners and managers also identied several

areas where the operation o individual budgetscould be improved in North Lanarkshire:

" Some people wanted the process to be quicker.

" Questions in the RAS could be made morefexible and more specic or specic groups

o people, to refect their needs moreaccurately.

" As individual budgets run alongside theexisting benets system, this can make

the administrative task o keeping track oincomings and outgoings highly complicated.

" The process o identiying individual budgetsas the most appropriate support option could

take a long time.

" As the individual budgets system wasrunning alongside existing support systems,practitioners didnt always eel that they were

being allocated the time necessary to reallydevelop and review personal support plans.

" Making sure North Lanarkshire employs aindividual budgets champion to act as a

source o support, advice and inormationor those wishing to receive the money rom

an individual budget, amily members andpractitioners.

"

Ensuring that expertise and commitmentto the In Control approach is widely shared

throughout the whole o North Lanarkshire.

Finally, people at the shared learning event wantedmore clarity on a range o issues concerning how

individual budgets worked, including:

" In the long-term, what the approvalsprocess or approving personal support

plans would be." For people over 65, how individual budgets

tted with denitions o ree personal care." How monitoring and review processes would

happen to ensure proper oversight withoutstifing creativity and imagination.

LISTENING AND LEARNING




" Inormation and support or peopleemploying personal assistants, in terms o

inormation and support on employer liability,payroll issues, CRB checks etc.

" Step-by-step guides to help all stakeholders

through the individual budget process." How potential conficts between individual

budget holders and amily members would beresolved.

" How fexible the individual budget could bewhen someone wanted to make changes to

their personal support plan.

" For people who were already using an

existing support package that they valued,inormation on weighing up the pros and

cons o personal support compared to whatpeople were already using.

" Where responsibilities lay in terms o duty ocare and dealing with unacceptable practices.

Looking ahead and key messages or InControl in ScotlandAlthough most o the day ocused on In Control in

North Lanarkshire, people at the event also raisedsome key messages or social support and/or care

systems in Scotland more generally, including:

" In Control provided the opportunity or a

real transormation in how people weresupported, with some people talking about

In Control becoming the new core businesso Social Work services.

" Such a shit also had the potential toradically improve the openness and

transparency o support systems or peoplewho use these systems.

" Such a shit would require major changesto current systems, with political leadership

required at a local and national level" Current complex processes or delivering

resources to people using support needto be untangled and made much more

transparent to people." Increasing transparency and fexibility

in how money can be used to achieveoutcomes or people may result in a major

increase in demand, or which systems andresponses would have to be ready.

ConclusionThe learning rom the In Control demonstration

Project in North Lanarkshire, and rom widerndings rom elsewhere in the U.K., convinces

North Lanarkshire Social Work sta and managersassociated with the work so ar, that it is the

direction o travel or the uture. The approach

is consistent with progress already begun on

developing sel directed support, to empower

people who need support to gain this in line

with their own personal needs and wishes, to

achieve agreed lie outcomes in a transparent andequitable ashion.

Beore the whole system introduction o the In

Control approach can be considered however,

urther steps are needed:

" People with support needs, carers, service

providers and politicians need to be

engaged in how existing systems and

arrangements need to and can change

"

A range o materials or sta, service usersand other key stakeholders needs to be

available to explain and explore how this

approach can deliver more positive lie

outcomes, social inclusion and citizenship.

" North Lanarkshire appropriate adaptations

to the RAS its supported sel assessment

questionaire, allocation o nancial

award to the scoring and overall nancial

aordability checked out

" Consideration o ongoing support or sta,

service users and carers to work in this newashion need to be on hand or those who

need this

" Agreement on which groups o individuals,

geographic areas, age groups or care groups

should next be identied or the approach

to be applied

" Consideration o service user contributions

to meet some costs associated with

support plans needs agreed

" A process to agree a staged route or

political agreement on progressing this

work needs to be considered

Social Work in North Lanarkshire is committed to the

radical changes we think are needed to help people

to improve their lives. We believe that this is the right

approach to the challenges faced by people, who

need assistance, their families and communities. This

might be done by providing advice, help to plan their

lives and/or to make direct support arrangements.

North Lanarkshire intends to continue its leadership

role in self directed support and therefore we have

entitled this report: Way Ahead.

Bobby Miller

Manager, Younger Adults


16/16

North Lanarkshire Council is the ourth largest

local authority in Scotland with a population oapproximately 320,000. The council recognises

the important role we play in the everyday lives othe local people we serve our Council motto is

service and people rst. When they think o NorthLanarkshire council, many local people will think o

the services we provide to them in their daily lives,such as housing, education and transport. As well

A social enterprise, In Control, has beenworking since 2003to transorm the current

social care system. In Control has worked inpartnership with UK central government, local

authorities and people who need support togure out a new way o organising the social

care system in the UK.

In Control Scotland was launched in January2007 as a partnership between Altrum and the

Scottish Consortium or Learning Disabilities,to promote the in Control approach and

system o sel-directed support in Scotland. InApril 2009, in Control Scotland was established

as an independent and separately constitutedorganisation in its own right and is a member

o in Control international

The intention o the work o In Control hasbeen to ensure that those people who need

support are able to lead lives as ull and activecitizens. In Controls work draws rom and

supports work undertaken by disabled peoplethemselves, the independent living movement,

and all o In Controls learning is shared openly.In Controls work to reorm social care eatures

key innovations o resource allocation and

in Control Partnerships Tel: 0121 708 3031 Email: [email protected] Website: www.in-control.org.uk

as these essential everyday services, we are alsoresponsible or providing help and assistance to

some o the most vulnerable and socially excludedmembers o our community.

We are charged with ensuring that those peopleliving in the area who need additional support

with everyday living, because o age or disability,have the opportunity to lead ull and active

lives as ull members o society. We recognisethis important group o local citizens and their

amilies have many strengths and talents but willalso need additional help rom time to time. This

report describes an exciting innovation in the waywe work to ensure the support people receive

rom the council is tailored to their own uniqueneeds, wishes and aspiration.

individual budgets, within a wider system osel directed support and these innovations

hold potential or wider welare reorm.

This report is an account o our work andthe things we believe we have learned by

implementing Sel-Directed Support in NorthLanarkshire. The ndings are not intended to

represent the results o an academic study;rather they are a critical sel evaluation o

progress to date. The ndings represent ourbest attempt to understand and report the

things people have said to us about theirexperience o taking control o an individual

budget.

I you would like more inormation about thein Control work in North Lanarkshire, please

contact us either by phone: 01698 332286;or e-mail: [email protected] .

About in Control and in Control Scotland

Email: [email protected]

Tel: 0141 418 5933

way ahead – north lanarkshire report

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