Next Steps on ISFsOutcomes of first Action Learning Sets

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• “It’s a no-brainer - all the benefits of direct payments without the hassle”

• “The service works for and with you.”

• “At long last you feel like a customer - you’ve got power.”

• “It’s about having a good life; not just about services.”

• “It’s about making things work better for everyone, people, families and the people who support you.”

• “Your personal budget is protected.”

Why people and families like ISFs

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The provider promise (contract)1. We will give you a clear explanation of our commitment to you.

2. We promise to design your support with you and around you, your family and community.

3. We promise to work flexibly and change things when necessary.

4. We promise to make sure supporters are properly trained.

5. We promise that your budget won’t be spent on anyone else, and any management fee is clear and agreed with you.

6. We promise to keep a clear record of your spending [in money or hours].

7. We promise to keep listening, learning and improving things with you.

8. We promise to help you find support from someone else, if we are no longer the right organisation for you.

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Why providers like ISFs• “ISFs are a useful tool that helps you be more creative.”

• “ISFs help you to treat people as real customers - or even better - as citizens.”

• “ISFs help you be clear about flexibility and what can be personalised.”

• “ISFs helps you get back to treating each other as human beings - with empathy!”

• “ISFs helps you work in partnership with people and families.”

• “It changes the conversation with commissioners and social workers: no models, no vacancies, no beds. It’s about what you can all do together.”

• “ISFs can end procurement and competitive tendering and increase collaboration with other organisations.”

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Why commissioners like ISFs• “It’s about building relationships and developing greater trust with social workers,

providers to working together for the same ends.”

• “It’s about getting things right first time - not having to recommission providers.”

• “It’s a legal option, and one we’ve now got to make real.”

• “It’s how we can break down block contracts.”

• “It’s how we can reduce procurement costs.”

• “It allows the market to shape itself.”

• “It still allows for contractual review and strategic development.”

• “It puts the focus on outcomes - not processes.”

• “Why wouldn’t we use this approach?”

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So - if it’s so good - why is it not happening?

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Major barriers:

1.Getting the right contract

2.Building it into procurement

3.Working with social workers

4.Enabling providers to start

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1. Finding the right contract…

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2 Party Contracts 3 Party Contract

There are 3 contracts, but actually less paperwork

Initially seems a purer approach to personal empowerment

Can be used when you can’t get sign up from the person Individual must sign up

A letter can cover contract between LA and person

3 copies of each signed contract required

Only one contract framework with provider necessary

Each new person needs a whole new contract

Easier to implement for people who may need support to make decisions

May be hard to get sign up for people who have limited mental capacity.

Easier when you want personalised support for people who challenge

Inappropriate for people who shouldn’t be free to terminate support.

So - 2 party contracts seem much better

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We have example contracts• Southwark - 2 way - 580 words - support planning

essential, but controlled by provider [working now]

• Birmingham - 2 way - 680 words - support plan defines budget but is only a ‘guide’ to practice

• Solihull - 2 way - 1,190 words - support plan is effectively part of the contract

• Warwickshire - 3 way - 2,700 words - support plan is part of contract and can only be changed by LA

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We identified the essential elements of a contract

that enables ISFs

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Core elements (1)1. LA agrees with Organisation to support P [named person]

2. Contract begins on [Start Date] and ends:

2.1. on [End Date] (if any) or with death of P (if it is earlier) OR

2.2. when contract is terminated

3. LA will pay Organisation £XX [per year or for some other period] to support P [personal budget]. The LA reserves the right to assess the needs of P and propose a revised budget from time to time.

4. Timing of payments will be specified [may include phasing]

5. Details of charging will be specified [net or gross]

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Core elements (2)6. Organisation will work with the person to help them meet their

needs and goals.

7. Organisation will plan with the person, changing any support provided as the person’s needs or goals change. [‘support planning’]

8. Organisation will record how they spend the person’s budget and will be able to provide a clear record to the person or to LA when required. [‘individual service fund’]

9. Organisation will charge the person no more than X% to meet the cost of managing support and for meeting their liabilities after the contract is terminated. [‘management fee’]

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Core elements (3)10.The contract will be changed if

10.1. The Organisation can no longer support the person for the agreed budget [‘seeking reassessment’]

10.2. The Organisation can now provide support at a lower cost than originally agreed [‘efficiency’]

10.3. The person’s needs or circumstances change (e.g. through ill health, staying in hospital etc.)

11.Contract changes must be agreed, and can include arrangements for repayment of unused funds.

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Core elements (4)12.Contract can be terminated with one month’s notice, if:

12.1.LA believes that needs of person are not being met

12.2.LA believes person is unsafe and needs different support arrangements

12.3.Person no longer wants support from Organisation

12.4.Organisation is no longer willing to support the person

13. LA reserves the right to terminate the contract immediately if it believes that there is an immediate risk to the safety of the person.

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Note that this contract could be amended to function as a framework contract and individuals, budgets and details about timing could all be specified separately.

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What about charging?

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1. GROSS - Commissioner pays the provider in full and bills the person. [It was proposed that it is much cheaper to pay everyone gross, and have only one system for billing.]

2. NET V1 - Commissioner pays net, organisation bills person. If person doesn’t pay, then organisation can bill the commissioner for the missing funding [subject to some defined rules].

3. NET V2 - Commissioner pays net and the organisation is commissioned to support the person to pay their charges. Commissioner will pay gross amount if the person resists payment. However, if people fail to pay, and their needs have been met then budget may well be reduced. [This kind of net payment system may be readily administered using pre-payment card systems.]

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Provider perspective: charging seems unfair - but if it’s necessary

they can cope with either approach.

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What about clawback?

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Two options for ‘clawback’• Contract for support - If support is provided on the

basis of a flexible contract then ‘clawback’ is impossible. Funding is the contract price and as such belongs to the provider. However opportunities for refunds, reductions and efficiencies continue to exist if contract allows for variations. [See clauses in contract above.]

• Variation on direct payments - If the ISF is treated more like a ‘managed direct payment’ (e.g. using a pre-paid card scheme) then the commissioner can empowers itself to reclaim or claw-back money that is unused according to defined rules.

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What about support plans?

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• If a support plan is included as an essential element of the contract then the contract does NOT enable effective use of ISFs - it undermines flexibility and specifies support. Don’t include support plans as part of contracts.

• Support plans can be used to define contract price (or personal budget) but they should not define ongoing support. Good support changes - all the time - good supporters are changing things as they learn how to make things better.

• A competent support provider should be able to change support without seeking permission.

• A social worker’s support plan may offer useful initial guidance, but it should be left behind as the provider plans with the person and changes plans over time.

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Changing contracts in practice1. You can allow for ISFs within a service level agreement for

statutory provider - the ISF can then be worked out at level of the individual.

2. Spot contracts can be amended for ISFs - just remove undue monitoring or service specification to enable flexibility of provision.

3. Allow people to authorise an ISF providers via their electronic account (or pre-paid card).

4. Allow ISF provider to administer an electronic account (or pre-paid card).

5. Allow a provider to break down a block contract into a series of ISFs.

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2. Modernising procurement…

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The use of ISFs implies that each individual has the right to opt in or out of any contract with a service provider. This means:

• Such contracts cannot be effectively aggregated, tendered or re-tendered - there is no ‘block’ of work to offer to the market as the decision must lie with the citizen

• Citizens should have good information about their options and the choice the chance to evaluate different options for themselves.

• Commissioners will need to create a framework contract and a list of potential service providers. They should put no unreasonable blocks in the way of new providers entering the market.

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How can you tender for a service that an individual

can choose or reject?

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It seems highly likely that if the commissioner creates the necessary conditions for the use of ISFs then it will meet its responsibilities under:

• The Care Act gives citizens rights to choose their own support. [Care Act 2014, Statutory Guidance for Implementation, Care and Support and After-care (Choice of Accommodation) Regulations]

• EU Procurement and Light Touch Regulations aim to open up markets to competition and to forbid market-fixing to favour particular providers. There is no intention to forbid citizens making choices for themselves.

• Localism Act and Social Value Act enable local communities to define their own priorities and to build on local capacities.

It is hard to envisage how to the proposed procurement structure would conflict with any of this legislation. It seems more likely that forbidding individuals from choosing their own provider or over-specifying how support is to be delivered will lead to legal problems for local authorities.

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3. The social work role…

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• “It’s like direct payments, but without all the fuss.”

• “I’ve seen it turn people’s lives around”

• “It’s like doing proper social work.”

• “You can be more creative and flexible.”

• “You can help people find the right service provider for them… you don’t need to go through brokerage or commissioning systems.”

• “The provider focuses on the details.”

• “We get to work with people, families and providers - working as equals.”

• “It helps us concentrate our time on the people who really need us.”

• “It makes the review process much more satisfying.”

• “The Care Act demands we work like this.”

Why social workers like ISFs

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The new social work script1. You can have a direct payment, or

2. You can have an Individual Service Fund:

2.1.You get to pick the provider, and you can leave them if you don’t like them.

2.2.Your budget is held by the provider, but how it is spent is decided with you.

2.3.We’ll help you find the right provider.

3. Or we will find and organise the support for you.

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Options for calculating budget1. Use a RAS to set the budget before picking service

provider or developing any support plan.

2. Let providers convert existing services into ISFs - working within existing overall budgets.

3. Use direct payment methodology to cost up plans - but use the agency rate to set the budget.

4. Develop a support plan, specify support in hours and then use existing agreed hourly rates to set final budget.

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How to review flexible packages

• The type and frequency of any review should match the level of risk.

• People who can advocate for themselves or where people have strong circles of support will need less social work input.

• People who are in institutional or abusive environments, or people who are lonely will need more social work input.

• The best basis for any review is human contact, conversation and exploration of how life is going - focusing on outcomes.

• People and providers should be expected to develop their own personal approach to sharing information (e.g. use of film, using a quiz format etc.)

• Providers should be allowed to test and develop their own models for managing quality and demonstrating achievement.

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4. Working with providers…

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A few providers who are already willing & able:

• Choice Support

• Beyond Limits

• iDirect

• Partners for Inclusion

• Midland Mencap

• New Directions

• Heart of England

• Somerset

• Milestones Trust

• Yarrow

• Alzheimer’s Society

• Many more…

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Where are ISFs useful• Domiciliary care - can feel too hard - ‘time and task model’ - contracts

being slimmed - electronic monitoring - but, being used in Calderdale and in principle could transform care.

• Supported living - leadership on the ground, more resources available - person-centred legacy - money covers lots of needs - should be easy.

• Day centres - a route to community engagement - removing the specification of how people should live - ripe for redesign. A better alternative to direct payments. cf. Worcestershire & Cambridge work.

• Extra-care sheltered housing - possible work starting in South Gloucestershire.

• Brokerage - for complex cases - people getting support from different sources. cf. Imagineer

• Personal Health Budgets - examples in Devon - ISFs started with providing support to people with most complex needs.

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Training implications1. Leadership - ISFs are a tool for working creatively and individually with people - if this not

understood at the level of leadership most of the important changes necessary won’t be achieved, because if ISFs are proving useful at the level of the individual then they should be causing disruptive (if productive) change in organisational arrangements. Leaders need to think about their strategy - not just expect positive change - and support people as they start to help people make changes and support the organisation to make the systemic changes that will make this process easier and natural over time.

2. Administration, personnel and finance - ISFs do require a different way of tracking information, not just about money but potentially about information, staffing and policies and procedures. One of the major issues, beyond the obvious accountancy issues, is staffing as it is common for people to want more personal control over who supports them. This is possible, but requires a very different approach from most service providers.

3. Creative service design - Planning is obviously important, but often planning has become meaningless exercise and training in person-centred planning can just make the plans prettier, but no more meaningful. I think therefore that it is better to focus on service design and the practicalities of helping people achieve better outcomes and greater citizenship. So I’d be wary of talking about planning per se, as this has often not had the hoped for outcomes. Instead I’d focus on the art of helping people advance their citizenship to achieve the outcomes that are important to them. I’m happy to talk more about this. 

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• Be strategic - what’s the long-term goal?

• Keep an eye on overall financial impact

• Change requires leadership

• Keep everyone onboard - give everybody an ‘escape route’

• Let services develop in their own unique way - learning with people - don’t push your preferred models on to people or providers

• People and families must be at the heart of the process of change - not consultation - but real innovation - seeing ‘providers’ as community organisations and as partners

• This is about a real shift in power - focus on what makes this real

• Innovation has a natural shape - starts small, grows by becoming easier, natural and low cost

• Failure is critical - making failure easier and safer is critical

• Stay unexposed as long as possible - innovation needs protected space

• Allow people to choose seemingly less personalised options

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• Alison Atkinson (Warwickshire)

• Antony Thorn (Solihull)

• Carol York (Telford)

• Tim Moore (Telford)

• Julia Fellows (Warwickshire)

• Louise Ferro (Sandwell) -

• Ian Gardner (Herefordshire) - may be available in afternoon

• Chris Howells (CfWR & Koru)

• Jo Jarman (New Directions)

• Chris MacAdams (Birmingham) -

• Ria Palmer (Sandwell) -

• Lorna Reid (Dudley) - apologies

• Maxine Shakespeare (Coventry) -

• Helen Turner (Social Care Insight)

• Simon Duffy (Centre for Welfare Reform)

• [attendees in bold]

Members of WM ALS:

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• Ann Lloyd (Hammersmith & Fulham, RBK&C, Westminster City Council)

• Christine Baker (Hammersmith & Fulham, RBK&C, Westminster City Council)

• Jackie Swapp (Alzheimer’s Society Kent & Medway)

• Clare Skidmore (Medway Council)

• Ben Anyanwu (Yarrow)

• Raj Mungur (Yarrow)

• Simon Duffy (Centre for Welfare Reform)

• [attendees in bold]

Members of London ALS:

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• Jenny Date (Carer using ISF)

• Simon Duffy (CfWR)

• Steve Jones (Somerset)

• Steffan Lewis (S. Glos.)

• Linda Phelps (Milestone Trust)

• Sam Sly (CfWR) - available for next ALS

• Naomi Taviner (S. Glos.)

• Helen Toker-Lester (Devon & LGA) - apologies

• Michelle Wiles (Somerset)

Members of SW ALS:

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Just some of our actions• Linda Phelps is going to help someone write to

South Gloucestershire to request an ISF.

• Linda Phelps will explore whether a global shift to ISFs in Bristol might help resolve current issues.

• Steve Jones and Jenny Date will write up case study for publication.

• Chris Howells and Simon Duffy to develop paper on procurement challenge.

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www.individualservicefunds.com

FIND OUT MORE:

http://www.centreforwelfarereform.org/library/by-az/commissioning-and-community-sourcing.html

http://www.centreforwelfarereform.org/library/by-date/community-sourcing-and-social-care.html

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