transition to transformation of adult social care
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Putting People First: Personalisation Toolkit Planning for transformation framework: Stage summaries Gateway ref 9878 This document is part of the Personalisation Toolkoit, which can be seen in full at www.toolkit.personalisation.org.uk. Transition to transformation of adult social care - PowerPoint PPT PresentationTRANSCRIPT
Putting People First:Personalisation Toolkit
Planning for transformation framework: Stage summaries
Gateway ref 9878
This document is part of the Personalisation Toolkoit, which can be seen in full at www.toolkit.personalisation.org.uk
Transition to transformation of adult social care
When moving to transformation we have found that councils can:• Clearly articulate the concepts and benefits of the transformation
agenda• Relatively easily put processes in place to manage trialsHowever, we found that some councils:• Struggle to communicate the scale of change required for total
transformation to key stakeholders• Find it difficult to plan activities required for total transformation• Cannot always obtain a clear picture of the informal support that
exists within the community• Are not always clear on what decisions should be taken when, and
by whom• Don’t always have a clear picture of what the ‘future organisation’
looks like
Planning for transformation: introduction
We have developed a Personalisation Toolkit that:• Helps local councils understand what key decisions they
need to take and in what order to move towards transformation
• Specifies the iterative transformation cycle and the products that are needed at each stage
• Suggests minimum and ideal levels of stakeholder buy-in and involvement in co-production at each stage
• Acknowledges that the planning for transformation framework itself is high-level and flexible
Planning for transformation: co-production
• Co-production is a key part of this agenda• Real change can only happen by engaging users and carers
throughout • Personalisation means empowering people to develop solutions
that work for them
Putting People First… “seeks to be the first public service reform programme which is co-produced, co-developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services and to win the hearts and minds of all stakeholders’, especially front line staff”
Transformation framework: summary
Phase 1 Full PotentialSwitch On
Investigation
Blueprint(Develop)
ImplementationPlanning
Implementation
InvestigationBlueprint(Enhance)
ImplementationPlanning
Implementation
Blueprint(Review)
ImplementationPlanning
Implementation
Limited Launch Expanding the new approach to all
Optimising the systems
Monitor & Sustain
Transformation framework: summary
• Co-production and development of an outcome-based vision.•Create project team &governance structure• Understand existing Processes and costs• Test financial Sustainability• Build components (e.g. RAS)• Identify benefits and Success criteria.
Phase 1 Full PotentialSwitch On
• Implementation as default option for all new clients• Rollout training andcommissioning• Review efficiencies• Driving choice in the market
Investigation• All staff on board and delivering• IT support for customers operational• Real choice in the market• System operating to full efficiency • Programme team winds down – business as usual
Limited LaunchExpanding the new
approach to allOptimising the
systems
Trialling or piloting
• Trial phases happen separately from the strategic planning necessary for total transformation
• We recommend that councils undertake trial phases as soon as practical (in Investigation or Blueprint stage in “Phase One”)
• It is essential to understand that the processes and procedures put in place from the trial phases may differ significantly from those in the transformed service
• The practical lessons learned and parts of the process refined through trial phases are essential to being able to implement total transformation
Initiation
• The case for change is strong but resources still need to be committed to investigating transformation before further work can commence
• In this short stage, in order to progress to the next stage, the management team need to sign-off a resource plan outlining what will be required to properly investigate transformation and how these resources will be found
Stage summary: initiation
Activities 1 week
Develop resource plan for next stage
Present to management team
Objectives and description
The objectives of this stage are to:•Demonstrate to stakeholders that transformation should be considered•Decide how transformation should be investigated
Deliverables Decision point & criteria for moving on Estimated resources
Report to management teamResource plan for next stage
Is it clear how transformation will be investigated?
1 analyst/project manager for 1 week
Risk register: initiation
Investigation
• We recommend this stage start and end with a transformation strategy workshop with the management team
• The first workshop should be used to outline the principles, scope and success factors
• This should then give a sufficient basis to consult with key stakeholders, particularly people who use your services, and their families, members; relevant community support groups and senior staff in other council departments, to develop a vision, generate buy-in for self-directed support and the wider transformation agenda, and engage users in co-production
• The second strategy workshop with the management team should approve the developed vision, scope and success factors and allocate resources to developing a Blueprint
• A template slide pack for the initial workshop and report for the second is included as part of this toolkit toolkit.personalisation.org.uk
Stage summary: investigation (Phase 1)
Activities 6 weeks 8 weeks
Project management
Communication
Transformation vision workshop 1 (with management team)
Develop transformation vision, scope & success criteria
Consult with all stakeholders (including on co-production)
Transformation vision workshop 2 (with management team)
Develop resource plan for next stage
Objectives and description
The objectives of this stage are to:•Develop a vision for transformation in the council.•Understand the scope of transformation and relationship with other initiatives.•Decide that a Blueprint for transformation should be developed.
Deliverables Decision point and criteria for moving on Estimated resources
High-level vision for transformation (developed through co-production).Resource plan for the Phase 1 Blueprint Stage.
Do you have agreement to develop a Blueprint?Agreed vision and viable resource plan for the Phase 1 Blueprint Stage.
1 full-time analyst/project managerPart-time communications officer (2 dpw) & co-production liaison (2 dpw)Administrative suport (1dpw)Part-time SDS sponsor (2 dpw – ideally AD level)
Risk register: investigation (Phase 1)
Key risk Type Mitigating action
Vision is not agreed by all key stakeholders Strategic Co-produce vision with key stakeholders to ensure a common vision is agreed. Invest in the leadership of people who use services and their families to maximise their potential to influence the planning.
Scope of transformation is defined too narrowly meaning that important work is missed out in later stages
Strategic Ensure that full implications of transformation are considered, including preventative internal and external services.
Links with other programmes are not effectively established resulting in duplication of work or opposing projects
Strategic Ensure decision are made at a senior level to join up work programmes from the outset and agree how central transformation is to be in order to ensure that the investigation and any subsequent work is effective.
Failing to secure sufficient resource for the next stage.
Strategic Ensure resource plan for investigation is robust and agreed at a senior level. Identify key skills and individuals to work on the Phase 1 Blueprint Stage.
Fit with existing initiatives
• Many councils have plans, models or visions that reference self-directed support or personalisation. However, very few have a structure and change programme that is designed to deliver total transformation
• Each council needs to take a strategic decision about how transformation will fit with existing initiatives
• Many existing projects will be different but complementary to the introduction of transformation – such as those to introduce early intervention, enablement or crisis support services – work will need to be done through planning to establish the interface with the self-directed support system
• This needs to take into account local circumstances including:• Capacity of the organisation to change• Existing service delivery arrangements (e.g. partnership delivery with PCT)• Level of commitment at senior level to transformation
• We think councils have three basic options when aligning transformation with existing modernisation programmes
How transformation relates to existing corporate change programmes is key
Option Run as a set of stand alone projects
S Run as sub-programme and re-align existing
projects
Re-design programme with transformation as
central focus
Benefits • Easier to manage as individual projects• More flexibility to innovate and take risks.
•Maintains momentum of current projects.•Helps to join up transformation•Acknowledge scale of change.
•Ensures transformation is sustainable in the long-term and benefits are realised.•All parties are signed up to one “vision” for adult social care.
Risks •Confusion about project priorities and dependencies.•Transformation benefits not fully realised.•Organisation not sustainable long-term.
•Possibility of lack of consistency with other projects•Can dilute the “vision”.•Harder to mainstream the cultural change.
•Significant resource investment.•Greatest change management challenges.•Possible loss of momentum during re-design
Conclusion Not appropriate for transformation.
Acceptable if good, operational change
programme in place.
Recommended if good, operational change
programme in place.
Fit with existing initiatives
When assessing fit with existing initiatives it may be helpful to consider the following:
• Do you have an existing change programme?• Do you have a well established programme and project
management methodology?• Do you have project and programme resources?• Do you have a vision for change?• Is personalisation at the centre?• Does your programme meet the government’s requirements in
‘Transforming social care’:• Personalisation/self-directed support?• Common assessment of individual social care needs?• All individuals eligible for publicly-funded adult social care will have a personal budget?• Transparent allocation of resources?
Fit with existing initiatives
When assessing fit with existing initiatives it may be helpful to consider the following:• Many councils have plans, models or visions that reference self-
directed support or personalisation. However very few have a structure and change programme that is designed to deliver total transformation.
• Each council needs to take a strategic decision about how personalisation will fit with existing initiatives.
• Many existing projects will be different but complementary to the introduction of transformation – such as those to introduce early intervention, enablement or crisis support services – work will need to be done through planning to establish the interface with the transformation system.
• This needs to take into account local circumstances including:• Capacity of the organisation to change• Existing service delivery arrangements (e.g. partnership delivery with PCT)• Level of commitment at senior level to transformation.
• We think councils have three basic options when aligning transformation with existing modernisation programmes.
Programme/project management
For guidance on programme and project management please refer to:
• Prince 2www.prince2.org.uk/home/home.asp
• Managing successful programmeswww.programmes.org/home/home.asp
• Useful documents on Product Sharewww.productshare.org.uk/pp/publications/projects.asp?ID=5966
Blueprint
• The Blueprint stage is focused on determining the shape of the future organisation
• We recommend that you start with how the organisation will look in the future, after the changes have been embedded
• This is not about planning the detail of implementation or identifying all of the issues that will be faced in the first year
• This stage will need to be repeated at the beginning of the “Switch On” and “Full Potential” phases to provide the opportunity to reshape the Blueprint based on evaluation feedback from the previous phase
Blueprint
There are two distinct phases to this stage:
1. Strategic decisionsConsidering the big questions about how the organisation will look.
2. Operational designWorking out how these strategic decisions will look in practice. We recommend that this is initially at a fairly high level , and that it incorporate a degree of co-production.(i.e. not Business Process Re-engineering)
Stage summary: BlueprintActivities 6 weeks 12 weeks
Prog management & communication
Commissioning
Customer journey
Back office
Support & planning brokerage
Manage the money
Resource allocation
Finance case
Resource plan for next stage
Developing the Blueprint
Objectives and description
The objectives of this stage are to:•Develop a future operating model for the new organisation based on transformation•Develop a sustainable financial model for adult social care costs, including the first cut of a Resource Allocation System•Understand at a high-level the back office organisation functions required to support the new model •Map out the interface with enablement, prevention, crisis support and early intervention services•Communicate and engage in co-production over the proposed changes with the key stakeholders both internal and external to your authority
Deliverables Decision point & criteria for moving on
Estimated resources
Target operating modelFinancial modelResource plan for next stage(Implementation Planning)
Has your Blueprint and Resource Plan for the next stage been signed off?
Full-time programme managerMinimum of 5 workstream leadsPart-time resources for finance and adminPart-time SDS sponsor (2 dpw)Resources to support involvement of users, carers and userled organisations
Strategic decisions
Operational design
Risk register: blueprint
Key risk Type Mitigating action
Implications for commissioning are not understood at a high-level and so poor decisions are made
Financial Consider having short-term commissioning plan in place – including avoiding entering long-term, binding commissioning arrangements until implications of transformation have become clearer
The new service blueprint fails to match how customers need/want to interact with adult social care and the proposed customer access channels
Strategic Engage with users, carers and user-led organisations through co-production. Make use of previous surveys/customer intelligence. Carefully work through implications for customers of any changes proposed
The new service blueprint fails to remove existing barriers to access for some groups of people, or constructs new ones
Ensure involvement of people with experience of relevant barriers. Undertake Equality Impact Assessments where appropriate
Employees and/or unions are unhappy and uncooperative about proposed changes to adult social care
HR Ensure social workers, other adult social care staff and unions are fully engaged in the development of the new model for adult social care
New adult social care model does not meet the legal requirements binding local authorities
Legal Involvement of legal and audit teams in development of blueprint. Keep up-to-date with Department of Health guidance
Failure to develop robust understanding of how to manage adult social care budget under self-directed support model
Financial Test, challenge and refine the financial model. Understand local limitations on levers for financial control. Ensure RAS and financial model interdependencies are understood.
New service blueprint is unlikely to be implemented due to unrealistic assumptions or lack of senior member/officer support
Strategic Regularly test out assumptions and expose them to challenge outside of the project team. Involve senior members and officers through the blueprint development.
Failure to secure significant resource for the next stage Strategic Ensure resource plan for investigation is robust. Identify key skills and individuals to work on next stage
Target operating model
• After developing a high level vision for transformation, local authorities need to develop a target operating model for their Blueprint in each phase
• This is a detailed view of what the organisation will look like in the future
• Very few councils have a target operation model that recognises the scale of change that total transformation entails
• Most advanced councils have a vision underpinned by some financial data and a high level customer pathway with some aspects of the target operating model developed
• It is assumed that, in line with Putting People First, this blueprint will be co-produced with people who use services and their families, including user-led organisations
Key elements of the Target Operating Model
For a detailed breakdown of the customer journey elements of the Target Operating Model, see Self-directed Support Process document.
First contact - advice and signposting
Meet immediate needs and enable
AssessCalculateinitial personal budget
Support planAuthorise&validate
Universal services and early intervention
Go liveMonitor & review
Suggested workstreams for developing the Blueprint
Process
OrgDesign
Finance
ICT
Governance
ChangeMngmt
Example: Specific organisation design work stream for entire customer journey
Example: Work stream focused on particular element of customer journey
Example: Specific IT works team which also picks up process in some elements of the customer journey
First contact - advice and signposting
Meet immediate needs and reable
Assess
Calculateinitial personal budget
Support plan
Authorise&validate
Universal services andearlyintervention
Go liveMonitor & review
Implementation planning
• Having established how your service will look in a few years time, this is now the stage to start planning how you will implement and produce a detailed plan for the first year
• You will need to pay particular attention to:• Reengineering processes to fit the new ways of working• Training staff• Developing information systems• Working with current and potential suppliers in the voluntary and private sectors • Refining the resource allocation system
Business process reengineering
For guidance on BPR please refer to:
• Business Improvement Package resourcesbip.rcoe.gov.uk/rce/core/page.do?pageld=40236
• Sprint – public sector developed methodologywww.sprint.gov.uk
• Care Services Efficiency Deliverywww.csed.csip.org.uk
Activities 3 months 6 monthsProg management & communicationDevelop detailed implementation plan
Business Process Reengineering
Training and development
Technology
Commissioning programme
Resource allocation
HR changes consultation
Detailed budgeting for first year
Resource plan for next stage
Stage summary: implementation planning
Objectives and description
The objectives of this stage are to:•Determine the detail of the future organisation•Determine how quickly the transition to self directed support will take place•Prepare the organisation for transition to the new mode of operating
Deliverables Decision point and criteria for moving on Estimated resources
Programme team structureDetailed implementation planResource plan for next stage
Do you have sign-off and funding to implement Transformation?Implementation plans & resources signed-off by Cabinet and officers with buy-in from key stakeholders
Full time programme manager4 FTE workstream leads2 BRP analysts (full time)Part time resource for HR, IT, communications, co-production, finance & admin
Risk register: implementation planning
Phasing implementation
Implementation will occur in each of the three phases of the iterative cycle.
• There is no universally correct way to phase implementation• Potential criteria include:
• Reengineering new clients/transitions/reviews• Locations• Client group • Type of current provision (services/cost)• Wide vs. deep (initial implementation with lots of people at a basic level or few people with higher quality)
• You need to pick what is most appropriate for your locality
Managing financial sustainability
• When planning for implementation, it is important to devise a strategy that will be financially sustainable
• Councils will need to consider where early savings will come from (to offset anticipated increase in demand):• High cost placements?• Process improvements to reduce inefficiency?• New users/transitions?
• Transition arrangements may be needed for some individuals:• Person’s budget increases/stays same – none• Person’s budget decreases & in long-term residential care – transition arrangements may be needed • Person’s budget decreases but not in residential care – to be agreed on an individual basis
Stage summary: implementation
Activities 1 year 2 years 3 years
Prog management
Communication
Phased roll-out of personal budgets
Commissioning programme
Training and development
Objectives and description
The objectives of this stage are to:•Fully implement self-directed support in adult social care•Deliver a sustainable service that meets needs by the end of the stage
The phasing of this stage will vary significantly from council to council depending on the decisions they have takenThe activities above are illustrative only
Deliverables Decision point and criteria for moving on Estimated resources
Performance metrics Has implementation been successful
Full time programme manager2 FTE workstream leadsPart time resource for IT, communications, co-production & admin
Risk register: implementation
Monitor & sustain
• The process and many of the tools you used will need to be continually improved
• It is important to agree early on:• What to monitor• When to review• Who will take responsibility
• This represents a major change – you shouldn’t expect to get everything right first time
Stage summary: monitor and sustain
Risk register: implementation
Additional guides, examples and templates to support councils with their transformation
programmes can be found at www.toolkit.personalisation.org.uk
This framework and accompanying templates were developed by iMPOWER on behalf of the Department of Health. Thank you to the Individual Budget Pilot Sites, in particular to Lincolnshire, Barnsley, Oldham and other
authorities, for support with the development and testing of this framework.