Making it Personal How to commission for personalisation – guidance for commissioners and others in children’s services

by Claire Lazarus, Clive Miller and Judith Smyth funded by the Department for Education KIDS Making it Personal programme

September 2012

Making it Personal

Contact details

Main point of contact Claire Lazarus

Telephone 0845 055 3900

Email CLazarus@opmassociates.co.uk, JSmyth@opmassociates.co.uk

If you would like a large text version of this document, please contact us.

Contents Who is the guidance for?..........................................................................................................1

How to use the guidance..........................................................................................................2

Introduction...............................................................................................................................3

1. Understand – stage one of the commissioning process.......................................................6

Understanding personalisation...........................................................................................7

Co-production.....................................................................................................................8

Policy drivers ....................................................................................................................11

Culture change .................................................................................................................18

Personalisation in the round.............................................................................................20

Understanding ‘needs’......................................................................................................25

Understanding the present system and what is available – mapping...............................26

Understanding cost and value..........................................................................................28

Benchmarking information................................................................................................30

Understanding outcomes..................................................................................................32

2. Plan – stage two of the commissioning process ................................................................33

Strategic commissioning – basic roles and responsibilities..............................................37

‘Must do’ standards for whole system – or commissioning principles ..............................38

Commissioning policy.......................................................................................................39

Strategic plan....................................................................................................................39

Annual budgets and plans................................................................................................41

3. Do – stage three of the commissioning process ................................................................43

New systems and processes............................................................................................44

Changing culture and behaviours.....................................................................................47

Developing the market of service provision......................................................................49

Workforce planning and development ..............................................................................52

Information to support individual choice ...........................................................................52

Different ways of commissioning......................................................................................55

Procurement techniques...................................................................................................56

Joint and collaborative commissioning .............................................................................64

4. Review – stage four of the commissioning process ...........................................................67

Performance management ...............................................................................................67

Taking a proportionate approach......................................................................................68

Appendices.............................................................................................................................70

Appendix 1 – Glossary of terms .......................................................................................70

Appendix 2 - Seven Steps of Self-directed Support34.......................................................73

Appendix 3 – Common Delivery Model ............................................................................76

Appendix 4 - Cambridgeshire County Council’s Care Package approval process...........77

Appendix 5 – West Sussex County Council’s Dynamic Placement System.....................78

Appendix 6 – additional sources of support......................................................................80

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Who is the guidance for? This guidance will be useful to people wanting to understand how the whole system needs to be changed in order to improve outcomes for children, young people and families. It will be of particular interest to those looking to improve outcomes through personalisation and personal budgets, as well as those concerned about the future of specialist services for particular groups of children and young people.

The guidance is primarily designed for strategic commissioners: lead members, health and wellbeing boards, children’s partnership boards, directors of children’s services, strategic and operational commissioning teams and clinical commissioning groups.

We believe it will also be useful to the following groups, all of which are able and may need to work closely with commissioners in order to improve services for all children:

Parents, carers and young people who want to influence decision makers to reform the system as active citizens, advocates and expert users of services.

Service providers, including social workers, care workers, physiotherapists, speech and language therapists, and health practitioners who work with children and young people.

Practitioners who work in mainstream services, including schools, and who need to know how to work with children and young people with personal budgets and how best to work as part of a personalised system. This is particularly important for the many different practitioners who may be working as a care coordinator/lead professional or practitioner/broker/key worker and who need to know how best to participate in the single assessment and planning process and operate as part of the team around the child/family.

Children’s centres, schools and colleges who want to improve the way they work with disabled children and young people and their parents and carers and with others working with them in other parts of the system.

Above all we draw attention to the need for parents, young people and all agencies to work together across the system in order to achieve change. Experience shows that unless there is widespread understanding of personalisation and what it can achieve and people across the system are committed to it – including providing leadership for it - then change will be impeded, slow and difficult.

The Commissioning Support Programme (CSP) published Delivering Better Outcomes for Disabled Children in November 2010. The document explores effective practice and provides practical resources for commissioning for better outcomes for disabled children. It includes emergent and promising practice on needs assessments, commissioning strategy, service planning, market shaping and procurement and improving performance management, ‘top tips’ for commissioners as well as links to other resources and expertise. See: CSP.

This guide is designed to supplement materials for commissioners published by CSP and others.

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How to use the guidance We are indebted to those commissioners, providers and parents/carers from across the country who have attended the national workshops on the draft guidance over the last 12 months and/or who fed back comments on the earlier drafts. We are grateful too to colleagues who have sent exemplar materials and who agreed that their contact details might be included in the guidance. This guidance is designed to be owned by the sector going forward.

Extending the personalisation of services is, we believe, exciting, empowering and right and will lead to improved outcomes for children, young people and families. We are conscious that during this time of austerity there is a major challenge to the system both in terms of maintaining and extending progress – we hope that this guidance will support the sector to ensure that personalisation remains at the top of the agenda.

There is no set way to use this guidance. We have deliberately designed it so that it can be used flexibly. It can be used with commissioners to extend their knowledge of the history and current policy surrounding personalisation. It can be used with health and wellbeing boards to support the development of policy and practice around the whole system changes required to support personalisation. It can be used with front line staff and parents/carers to extend their awareness of the commissioning process and how important it is to get the steps in the process right in order to embed and extend personalisation. We know from feedback from commissioners and others over the last 12 months that they have used the guidance in a wide variety of ways to develop the agenda.

The guidance includes links to dozens of other publications and websites where additional information and support can be found. In addition, two sets of PowerPoint slides are available to support its usage see: http://www.kids.org.uk/information/100347/106207/106214/making_it_personal/

Further copies of the guidance can be downloaded from either the KIDS website or the Local Government Association’s Knowledge Hub. Our ambition is that it will continue to develop and that additional exemplars might be shared in order that the sector continues to build on and learn from experience about how to extend personalisation.

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Introduction The Commissioning Support Programme definition of commissioning is now widely accepted as the universal definition of commissioning. Under this definition, commissioning is the process for deciding how to use the total resource available for families in order to improve outcomes in the most efficient, effective, equitable and sustainable way.

Figure 1 The Commissioning Cycle

Commissioners of children’s services are the people based in local government and PCTs who make decisions about how to spend public resources. NHS commissioning transfers to the National Commissioning Board and GP-led Clinical Commissioning Groups from April 2013.

In all systems there are three levels of commissioning to consider: strategic, operational and individual (personal budgets). All these are described in this guidance.

Commissioners need to understand personalisation and how to commission it.

Personalisation requires commissioners to think and work differently in order to change children’s services systems at all levels:-

Governance – the Health and Wellbeing Board and any separate overarching children’s board, should understand and agree that a personalised approach is what they want to achieve and that this will mean fundamental change to systems, culture and behaviour

Structures may need to change – in particular understanding personalisation will help commissioners to redesign systems and improve services so that there is a real focus on children, young people and families rather than on professional interests. Commissioners may need to procure new services or goods from existing and new providers or cease commissioning services that are no longer fit for purpose

Systems can be improved when holistic information is collected and then used to inform commissioning decisions – single assessment processes, including the Common Assessment Framework (CAF), have the potential to provide information about what is needed for children and their families and is most likely to work to

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improve their lives. This avoids the double counting of many existing systems where there are a multiplicity of referral forms and assessments and significantly reduces the strain on families of being subject to a multiplicity of assessments and referral

pathways1.

Frontline staff from every profession will need to be supported through training and development in order to change the way they work with families. Doing with rather than doing unto means working appreciatively with families to find out and build on their strengths and to encourage them to suggest ways in which their needs can be best addressed. These solutions may include family, friends and universal services.

Commissioning is very much about taking a whole systems approach. Good strategic commissioning includes careful analysis of needs and of what works to improve outcomes in order to inform decisions about how to organise, or re-organise, children’s services. Personalisation is not a new project or programme added to the many that already exist in children’s services rather it is an opportunity to improve the whole system at all levels.

This guidance is aimed at commissioners across children’s services. It draws particularly on experience and knowledge gained from the personalisation of services for disabled children and young people over the last decade.

There are many examples of personalisation and personal budgets for young disabled people. In Control’s publication ‘Personalisation, Children, young people and families’ includes learning from work with more than 30 children’s services over the past four years. This work has seen approximately 489 individual budgets agreed and put in place. See: In Control.

The concept of personal budgets has evolved from social care funding to one focussed on using funding from health and other parts of children’s services. See section on individual budgets, personal budgets and self directed support below (page 14).

There is evidence that a personalised approach works well for all children and young people including children and young people in need of additional and targeted support. OPM supported the Budget Holding Lead Professional (BHLP) pilots between 2006 and 2008. Funding for the pilots was divided between expenditure on developmental staffing and other work as well as for a fund for BHLP budgets. Key objectives of the pilots included to provide lead professionals with ‘access to, and leverage over, significant budgets’ in relation to individual children and to enable lead professionals to ‘access more responsive services and support for their clients’ by giving a budget with which to commission services direct from providers. Details about the pilots, including who took part and outcomes can be found at: OPM and further details can also be found on page 16 of this report.

Another good example of this approach in practice is ‘Think Family’. Family intervention projects (FIPs) offer a personalised approach from a think family practitioner who provides a stable relationship helping parents to get back in control and coordinating the services they and their children really need. Not only has evaluation of FIPs shown they work well for many families in great need but also they are more efficient than current fragmented

1 See Homes et al 2012 An exploration of CAF and duplication of referral systems.

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systems where it is still possible for a family to have up to 30 practitioners working with them. See: Think Family

DfE and DH are supporting 20 SEND Pathfinders comprising 31 local authorities and their

Primary Care Trust partners.2 The pathfinders are testing the feasibility of a single assessment and planning process for children and young people with SEN and disabilities from birth to 25 years. The pathfinders are charged with developing a more family focussed, personalised approach to delivering children and young people’s services. They are engaging with the voluntary and community sector (VCS), to explore the potential role of this sector, including whether they could coordinate assessment and bring greater independence to the process. Every pathfinder is also testing personal budgets as an essential part of the new system.

There is some evidence that personalisation and personal budgets for disabled children and young people are more likely to be firmly established if the approach is extended across children’s services. Personalisation involves whole system and behavioural change and is therefore not easy to establish effectively as a pilot. We have, therefore, deliberately included examples in this guidance that extend beyond services for disabled children in order to provide people using the guidance with additional material to use when trying to persuade colleagues in the wider system to make the changes needed.

The guidance is laid out using the commissioning cycle ‘understand, plan, do, review. The ‘understand’ section is the longest because it contains a full explanation of personalisation and the changes to traditional commissioning required if it is to be fully established. The ‘plan’ section explains how to plan for personalisation and contains examples of ‘must do’ standards and paragraphs from commissioning policies which you will need to establish personalisation fully.

Commissioning is all about change – there is little point in spending time understanding the current system if commissioners are not aiming to use that information to create a vision for a better system and drive change. Personalisation and personal budgets challenge many of the assumptions that have underpinned traditional services. The ‘do’ section of the guidance therefore includes information about how to lead and manage change.

Key points:

1. Underpinning personalisation is the recognition that services do not produce outcomes. It is what people do for themselves along with their families, friends and neighbours, supported or otherwise by services, that co-produce outcomes (see figure 2 below).

2. Unless services that are funded outside of personal budgets are also personalised and all of those services are redesigned to enable people to make best use, and further develop, their individual capacity and social capital the full impact will not be realised.

2 2 http://www.sendpathfinder.co.uk/pathfinder

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1. Understand – stage one of the commissioning process The first stage in the commissioning process is ‘understand’. For disabled children and young people this will include understanding their and their family’s lives, developmental issues, the incidence of disability in the local population and the resources available to meet those needs. It should include understanding the personal and community resources that families and children use and want to use. It should include mapping and costing existing services, assessing needs, applying evidence of what works to improve outcomes, listening to the views and experiences of service users, understanding service capacity and what needs to change.

Before we discuss this further it is necessary to understand personalisation itself and the changes to traditional systems, culture, behaviours and processes that are needed in order to embed it.

Jonathan’s story

Jonathan is a disabled teenager. His quality of life has been transformed since he left school in July 2008 with a personal budget. Now he and his mum decide what he should do, when he should do it and who should support him. Jonathan’s complex health condition means he receives funding through continuing health care. He was fortunate to be part of a pilot run by what was the Learning and Skills Council giving individual learning support funds. Putting the different funds together has enabled Jonathan to employ one full time personal assistant (PA) and two part time PAs to support him with activities in the evenings and weekends.

Jonathan’s mum reports an ‘amazing improvement in his quality of life. …It has given him so much more freedom to explore life. Without this personal budget he would not have been able to do anything like the things he can do now. I would have had difficulty taking him to these things. It is encouraging Jonathan to have a bit of an independent life style. And with Jonathan having his PAs, I have more time to spend with my other two sons who both have learning difficulties and Jonathan can’t stop smiling!’

In addition to enjoyment and happiness, Jonathan’s learning needs are fully taken care of. His week – tailor-made for him – allows many opportunities for developing his independent life skills, his special interest in computers and multi-media, and individual tuition.’

Extract from ‘Taking Control stories’ http://www.in-control.org.uk/site/INCO/Templates/General.aspx?pageid=715&cc=GB

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Understanding personalisation

Personalisation is the term first used by Charles Leadbeater3 to describe the move from a previous ‘consumerist’ approach to designing and delivering services to one that is empowering and led by the people who require some form of support. In a health context Leadbeater contrasts the two approaches as follows:

‘Consumerist – (service) users are patients in need of timely and effective services from the NHS that are personalised to their needs. The professionals – medical practitioners – must deploy their knowledge and skills in a timely and effective way to solve a problem for the user. The more that is done in a personalised, considerate and responsive manner the better.

Personalisation – the users are co-producers of the goods in question. They are active participants in the process – deciding to manage their lives in a different way – rather than dependent users…. The key is to build up the knowledge and confidence of the users to take action themselves, to self-manage their health without turning to the professionals. The professionals deploy their knowledge to help the users devise their own solutions – smoking cessation programmes, exercise regimes – which suit their needs.

The consumerist approach to public service delivery with its focus on the individual as a customer was a great step forward from the previous focus on delivering services as the end in itself. Personalisation built on and transformed this development through a number of key shifts in practice:

Customer service to outcomes and living a life – consumerism focuses on delivering more user friendly services. Personalisation starts from how people wish to lead their lives, focuses on outcomes, and then enables people to determine what services can best support them to achieve their goals.

Passive consumer to active co-producer – the term customer assumes that people should be served and the service they will receive will deliver the outcomes they desire. This neglects the role that people themselves play in delivering outcomes; for example, children as active learners, parents as supporters and nurturers. Personalisation explicitly recognises the role that people play in achieving the outcomes they desire and recognises that most outcomes are co-produced by what people do for themselves and others as well as the support they receive from services.

Professionally determined to supported decision making – with the recognition of people as active co-producers comes a shift in the relationship between people and professionals. The consumerist approach was based on the process of people having their needs assessed by a professional who then decided which services would best meet them. Personalisation recognises the expertise of both people and professionals and enables people, within the resources available, to decide what will work best for them.

3 Charles Leadbeater ‘Personalisation through Participation: a new script for public services’, Demos, 2004

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Co-production

Underpinning personalisation is the recognition that services do not produce outcomes. It is what people do for themselves along with their families, friends and neighbours, supported or otherwise by services, that co-produce outcomes (see figure 2 below).

Every Child Matters

Outcomes

Public sectorContracted

private sector

Voluntary organisations

Private sector- shops, jobs, finance, housing

Children …

… and their families

Communities andpeer groups

ORGANISATIONSPEOPLE

SOCIAL CAPITAL

Source: ‘Co-production in Children’s Services’, Clive Miller and Sue Stirling, OPM, 2004

Figure 2 The co-production of outcomes

Boyle and Harris4 in their definition of co-production highlight the need to promote equal and reciprocal relationships between people and professionals and also the wider social gains that come from recognising and supporting co-production.

Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.

Co-production isn’t something new that needs to be invented, it has always existed but has largely gone unrecognised in most service delivery practice and design. This has led to less effective and efficient use of the resources of both people and organisations. For example:

A child has to be taken to three different places for appointments with different services – this wastes parental time, incurs extra travel costs and disrupts the child’s education. It is also a barrier to accessing services leading to missed appointments and the consequential underutilisation of service delivery capacity.

A family with a child who has a physical disability needs a short break – in some areas, and particularly before Aiming High, the only type that is available is a residential weekend placement for the child. Both the child and the family find the

4 ‘The challenge of co-production’, David Boyle and Michael Harris, new economics foundation, the Lab and NESTA, December 2009

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separation stressful which undermines the intended impact of providing the break. They would much rather go away together to a hotel or an adapted caravan for a weekend which would also be far cheaper. However the way the short breaks budget was structured did not allow for this option.

In the past, the focus has been on the left hand side of figure 2, the organisational resources that are used to achieve outcomes. The view of those resources has sometimes been quite narrow. For example, we have tended to focus on a single public service whilst neglecting the crucial role that the private sector plays in making basic living resources such as food, clothing and financial services available to people. Meanwhile the right side of figure 2 – the potential resources of service users and the social capital on which they draw – has largely been neglected. This is partly because of the narrow way that what constitutes a ‘service’ is generally defined. When the personal resources of service users have been taken into account – for example, in community work and in personal services such as health and social care – our tendency has been to focus on people’s personal deficits and to try to fill these gaps with services. All in all, it’s hardly

surprising that little is known about people’s capabilities and their social capital.5

Redesigning services to enable much more effective and efficient co-production can deliver major benefits even in very difficult circumstances. For example the use of family group conferencing in safeguarding children (see box 1 over the page).

5 Extract from Coproduction of health and wellbeing outcomes – A scene-setting paper for discussion Vidhya Alakeson, Antonia Bunnin and Clive Miller July 2012

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Box 1: Family Group Conferences (FGC)

If a child or young person has been identified as in need of protection, local authority children’s services are responsible for producing a child protection plan. For that purpose, they will convene and run child protection conferences as required by the Framework for the Assessment of children in need and their families. (DH 2000). At these conferences, family members may attend, but the professionals are responsible for making decisions and drawing up the plan.

FGCs enable the wider family to come together to work out for themselves how they can play an active part in safeguarding a child who is in need of protection. Typically the process of enabling a family to come together and run its own conference identifies twice as many family members who are potentially available to help than traditional child protection conferences. FGCs are also far more likely to engage fathers and other male family members. The results are more likely to lead to agreements to use kinship care where the child’s own extended family rather than a foster parent or children's home provides the continuing safeguarding support. This produces better outcomes for the child

and is 12 times less expensive than providing foster care6.

The role of professionals in family group conferencing is twofold. Firstly the social worker who has responsibility for ensuring the child is safeguarded makes it clear why the child requires safeguarding and how any proposed arrangement for kinship care will be checked to ensure it can both safeguard the child and promote his or her continuing welfare. This setting of boundaries is extremely helpful to family members in negotiating appropriate arrangements amongst themselves. A facilitator, who is not a social worker but is trained in enabling families to come together and use family group conferences, explains the process to family members, helps them contact and invite family and appropriate friends to the conference and supports the conference process, including ensuring advocacy support for children if required, without intervening in the family decision making. The aim is to enable the family to have the best chance to meet and work together and negotiate a mutually acceptable solution.

Matthew Horne and Tom Shirley, in a Cabinet Office paper7 see co-production as requiring a new relationship between citizens and the state. They recommend that we move from the position where ‘currently citizens have little control over the resources that the government provides and are rarely encouraged to commit their own resources’ to one of ‘a new relationship between citizens and government that mobilises more of the resources necessary to achieving better outcomes’. Table 1 provides an overview of the resources they see as potentially being made available.

6 See www.opm.co.uk 7 ‘Coproduction in public services: a new partnership with citizens’, Matthew Horne and Tom Shirley, Cabinet Office, March 2009

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Table 1: The resources of government and citizens

Citizens’ own resources Government’s resources

Knowledge, skills and understanding

Energy, time effort

Will power and personal agency

Motivations and aspirations

Social relationships with families and communities

Money

Rules and regulation

Expert knowledge and skills

Energy, time and the labour of public service professionals

Leadership, expectations and aspirations

Policy drivers

In the UK personalisation is most closely associated with the use of personal budgets in adult social care. However, this is part of a longer stream of developments that is now continuing and broadening in scope to children’s services following the DfE’s individual budget pilots, DH’s personal budgets pilots and the SEND pathfinders.

Table 2: personalisation policy drivers and initiatives

1990 NHS & Community Care Act Care Management

1996 Direct Payments Act Legalised Direct Payments

2001 Valuing People Goal of citizenship

2001 Piloting of the Expert Patient Programme (EPP) in the NHS

Recognised, enhanced and used the expertise of patients to help one another8.

2003 In Control Self directed support

2005 Improving the life chances of disabled People & In Work Benefit Calculation

Individual budgets

8 http://www.expertpatients.co.uk/sites/default/files/files/Evidence%20for%20the%20Health.pdf

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2006 White Paper ‘Our heath, our care, our say’

DH funded individual budget pilots begin

DCSF budget holding lead professional pilots begin

Individual budgets for all adults

Budget holding lead professionals

2007 Putting people first

Aiming high for disabled children

In Control starts work with LAs to develop individual budgets for children with disabilities

DCSF funded BHLP pilots for children in care begin

Personal budgets for adults

Individual budgets for disabled children

2007 Health Foundation invests in large-scale demonstration programme Co-creating Health

Aims to embed self-management support within mainstream health services and equip individuals and clinicians to work in partnership to achieve

better outcomes9

2008 Darzi report ‘High quality care for all: NHS next stage review’

Personal health budgets pilot

proposed 10

2009 DCSF funded individual budget pilots begin

DH funded personal health budget pilots begin

Think Family

Family intervention project

Around 70 PCTS have been involved in piloting PHBs, of which 20 are taking part in an in-depth evaluation

2010 Coalition government confirms its support for personalisation and individual budgets

Supports and publishes evaluation of IBs for disabled children

9 See http://www.health.org.uk/areas-of-work/programmes/co-creating-health 10 See http://www.personalhealthbudgets.dh.gov.uk/About/faqs/

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2011 SEND green paper supports personalisation for disabled children

SEND pathfinders to focus on single plan, personalisation, greater involvement of the VCS and full engagement of children, young people and their families

2012 DH issue Liberating the NHS: No decision about me, without me – Further consultation on proposals to secure

shared decision-making11

Focuses mainly on giving people more choice of provider and over the time and place that they receive treatment and care

2012 SEND green paper next Steps document

Draft legislation on Reform of provision for children and young people with SEN published

Proposed Children and Families Bill

Government confirmation of their commitment to extend the choice of PBs to all families in receipt of a new Education, Health and Care Plan or a statement of SEN from April 2014

2012 DH publish draft mandate to the NHS Commissioning Board

Commitment to roll out the right to ask for a PHB in Continuing Healthcare from April 2014

The section below describes some of the key concepts associated with these policy drivers and initiatives in more detail

Care management

In 1990, as part of the development of community care for adults, front line care managers were enabled to assess people’s needs and then purchase packages of care to best meet them. Whilst this did not acknowledge the role that people play in meeting their own needs, or put them in the driving seat, it was a radical attempt to fit services to people rather than vice versa. However the use of block contracting to secure best value for money soon led to significant resources being tied up in pre-purchased services leaving most care managers in the position of gate keeping access to a limited menu of services.

11 Shared decision making is the process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences. Making shared decision-making a reality: No decision about me, without me, Angela Coulter and Alf Collins, Kings Fund, June 2011

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Direct payments

In 1996 as a result of the campaigning by disability lobby groups, and work by some innovative local authorities, it became possible for adults to receive a sum of money in the form of a direct payment to enable them to purchase the services they deemed would best meet their assessed social care needs. Direct payments are cash payments made to individuals who have been assessed as needing services, in lieu of social services provision.

Whilst direct payments led to some major differences in people’s lives and in the support they purchased their overall impact was lessened by low take up. This was partly due to lack of positive promotion by social services departments and partly due to many potential recipients being put off by having to become employers of support workers.

Individual budgets, personal budgets and self directed support

In 2003 In Control12, a not-for-profit organisation established in collaboration with Valuing People and some leading edge local authorities, began to develop ways in which people with learning difficulties could decide the support they required to live their lives including the help they needed to manage their own direct payments.

Whilst the individual budgets (IBs) provided to people via direct payments were essential to this development even more important was the underlying process of what became known as ‘self directed support’ (SDS).

SDS is a seven step process developed by In Control that enables anybody, either unaided or with varying degrees of support, to (within a given budget) plan how they wish to live; agree the plan with their local authority; and identify and secure the support required to do so. See Appendix 2.

Whilst the process of self directed support that underpins the use of PBs can vary, most are built on the seven step process. See ‘do’ below for more information about resource allocation systems.

An individual budget (IB) applies to an arrangement whereby a service user gains direct control over the application of funding allocated to them following an assessment process or processes, and where funding is sourced from a number of income streams held by local statutory bodies. The intention in bringing different funding streams together is to go beyond direct payment arrangements, and provide a more holistic and joined up package of support. With IBs, the service user is also offered the support of a broker to help manage the allocation provided – some of which may be in cash form, but can also be services provided in kind. The broker may hold the budget on behalf of the beneficiary.

Personal budgets (PBs) are an amount of money allocated to meet the outcomes identified through a person's self or supported assessment and support plan. Funding may come from several sources, including social care money. Originally the term applied only to social care funding but now it is often used interchangeably with the term ‘individual budgets’ at a national level. For the remainder of this paper, therefore, the term personal budgets will be used.

12 www.in-control.org.uk

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Personal budgets have been adopted as one of the core milestones13 in the roll out of the Putting People First transformation of social care. They are also now been piloted in health.14 The Government has stated its intention that, subject to the evaluation of the pilots, everyone in receipt of NHS Continuing Healthcare will have a right to ask for a personal health budget, including a direct payment, by April 2014. See Personal health

budgets: Early experience of budget holders.15

PBs in children’s services have been introduced more recently. They were first developed by Paradigm’s Dynamite project working with disabled children aged 14–25 years to smooth the transition to adult services in the North East Region. See Introducing individual budgets and self-directed support for disabled children, young people and their

families16.

The then DCSF made a commitment to pilot PBs for families with disabled children when they published Aiming High for Disabled Children.17 The Department commissioned six

pilots by local authorities and their PCTs which ran from 2009-1118.

The evaluation of these pilots19 showed they had a positive impact on people’s lives and delivered good value for money as well throwing up further challenges.

Evidence from the individual budgets pilots as well as evidence previously collected from parents and professionals in Newham20 have demonstrated that personal budgets can result in improved outcomes including:

Families enabled to use their own and other resources and personal budgets to support their sons and daughters to live full lives.

Families at the heart of developments, supported by other families.

Families clear about how much money they will receive to buy support for their child.

Children and young people more effectively enabled to become involved in activities in their local community with support as appropriate.

13 Progress measures for the delivery of transforming adult social care services, ADASS, DH, LGA September 2009 14 Understanding personal health budgets, DH 2009

15 www.york.ac.uk/inst/spru/research/pdf/PHBE4int.pdf

16 http://www.in-control.org.uk/media/105388/introducing%20personal%20budgets%20in%20medway%20children's%20services.pdf 17 Aiming High for Disabled Children (AHDC) Better support for families, launched in May 2007 was the transformation programme for disabled children's services. AHDC was jointly delivered by the Department and the Department of Health (DH). http://media.education.gov.uk/assets/files/pdf/a/aiming%20high%20for%20disabled%20children%20better%20support%20for%20families.pdf

18 http://www.education.gov.uk/childrenandyoungpeople/sen/ahdc/a0068208/ahdc-individual

19 Evaluation of the individual budgets pilot programme: final report, DCSF, 2008 https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR145.pdf

20 Personalisation for Children, Young People and Families, Briefing 3: Evaluation and Outcomes, Crosby, N. In Control 2011

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Families given greater choice about how they use their budgets.

Families given greater control over services.

Improved outcomes for children, young people and families.

Better partnership working between professionals and families in a user-led approach.

Greater transparency of costs.

In addition, stories taken from development work supported by In Control’s Taking Control programme illustrate the impact that PBs and self directed support can have on the lives of children, young people and their families.

Johnny’s* story21

Johnny is 10 years old and has cerebral palsy which significantly affects his trunk, arms and legs, which in turn has impacted upon his mobility. Johnny also has a learning disability and has high levels of difficulties with his communication. Johnny requires 24 hour care and support at home and in all other environments, his condition worsens in the cold winter months.

Johnny’s previous care plan included overnight breaks at a residential unit. His parents did not feel he was benefitting greatly from these overnight stays, as they did not feel the unit fully met his needs.

With their PB, the family used some of the money to pay for a worker to accompany them to Tenerife for two weeks in December/January i.e. during the cold weather, to assist with Johnny’s care. They also bought a pass for a rehabilitation unit in Tenerife which has specialist physiotherapy services. The pass enabled daily access to the unit which Johnny really enjoyed. The exercise, physiotherapy and warm weather greatly benefit Johnny’s health.

Johnny’s parents report a marked improvement in his health and general well-being since their return from Tenerife. He has gained weight and looks really well. They feel the benefit of two weeks in the sun has achieved a far better outcome in terms of Johnny’s health than many nights in the residential unit would have done.

*Name has been changed for reasons of confidentiality.

Budget holding lead professionals

Budget holding lead professional (BHLP) pilots for children with additional needs were funded by the then DCSF,22 23 during 2006–08. The pilots were tasked to work with children with additional needs whose needs placed them below the statutory threshold for intervention but who were typically receiving support from a number of services.

21 Extract from ‘Taking Control stores’, http://www.in-control.org.uk/site/INCO/Templates/General.aspx?pageid=972&cc=GB 22 Budget-holding lead professional pilots: final report, OPM August 2008 23 Budget holding lead professional pilots in multi agency children’s services, Newcastle University, DCSF, 2009

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The BHLPs were required to work with the individual children and their families to identify their needs against the five Every Child Matters outcomes, develop a jointly agreed action plan and then to secure the services the children and families identified as most likely to help them meet their needs. As part of the support process BHLPs were provided with budgets to be used to secure personalised support that was not available through currently provided or contracted services. In 2007 the BHLP approach was extended to work with children and young people who were looked after or on the ‘edge of care’.

Child with additional needs in receipt of two or more services identified, consent to work with a BHLP gained and BHLP identified

BHLP completes CAF assessment and outcome focused support plan with child, parents and relevant professionals

Adjust or confirm membership of Team Around the Child

Access BHLP budget, if required. Access existing and purchase new goods and services

Review outcomes and, if required, plan further support

Child and family -engagement throughout, coproducers of outcomes

Lead professional –one stop coordinator

Team around the child – proactive, work with child and family and LP, responsible for own services

Figure 3 The BHLP working process

Rather than being alternatives, BHLP and the use of PBs are now seen as a continuum of practices. Central to both is the principle of enabling the child and the family to be in the driving seat in deciding what will work for them and enabling them to make active use of their own resources and capacities as well as drawing on service supports as required.

This is accompanied by a shift in the relationship with professionals, described by one BHLP as moving to ‘working with, rather than doing to’. Equally important is the focus on the child and family’s life as a whole rather than one aspect of it. This often leads to children making far greater use of universal services and a different range of existing targeted services than any one professional would have considered before. Family issues which may be inhibiting the parents’ ability to parent effectively are also more likely to be identified and support provided.

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Culture change

BHLPs often stressed that paradoxically the success of BHLP was not down to how the BHLP funds were used, ‘It’s not the money’ rather it is the change in practice culture and the relationship between BHLPs, children and families that makes the real difference (see table 3).

Devolution of funding is critical as a tangible way of signalling that all support options are open and should be explored. Crucial too is making the funding contingent on the child and family being enabled to develop and agree an outcomes-focused support plan.

Table 3: BHLP: the culture and relationship change

Aspect of practice

‘Under developed ‘ practice The BHLP model

Outcomes focus

Services are often confused with outcomes or outcomes are described in general terms

Restricted focus on the five outcomes

SMART outcomes are identified

All five ECM outcomes considered and as a joint set

Child and parent engagement

Engagement takes the form of consultation. The child and the parent are not the prime movers in identifying their needs, capacity, outcomes and the support they require

Focus on detailing the support required to make up for lack of capacity

The child and parent is central to all stages of the formulation of the action plan which is written in an easy to understand format

Tasks that the child and the parent agree to undertake that make use of their capacity are made explicit in the action plan

Use of cash funds

Practitioners do not have funds allocated for them as individuals to spend

Cash budgets held and gate kept by managers.

Practitioners have to justify the use of funds

Funds are typically targeted on single needs

A restricted range of funds is tapped

Sustainability is not necessarily a major criterion for budget allocation

BHLPs have individually allocated funds

Funds can be held by a manager but not gate kept but BHLP must follow the BHLP process

Funds used as leverage to assemble an outcome-focused package of support agreed by the child and the parent

Full range of cash funds explored

Sustainable activities or change, not ‘top up’ funding

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Aspect of practice

‘Under developed ‘ practice The BHLP model

Coordination of action plan and its delivery

Only some practitioners are in a position to act as coordinators

Whoever is best placed takes on the full lead professional role

Team around the child (TAC)

Practitioner obtains agreement from the other service providers who mostly work independently with the child and relate ‘radially’ to the practitioner

Weak or no holistic overview of the needs of the child and their family

The Team Around the Child proactively collaborates in the delivery and review of the care plan; BHLP coordinates

TAC has strong collective responsibility for ensuring the desired outcomes for the child and family are delivered

Experience from both the BHLP and PB pilots is that some staff easily adopt the full model whilst for others it involves a more gradual change. Training on its own was found to be useful for awareness raising but, for most staff, did not result in behaviour change. The use of group supervision, following on from training, where staff could compare practice, challenge one another and be coached in the new ways of working was found to be very effective.

The 2011 Green Paper ‘Support and Aspiration: a new approach to SEND and Progress

and Next Steps document24’ is an exciting development. The Green Paper proposes the option of a personal budget by 2014 for all families with children with a statement of SEN or a new Education, Health and Education Plan.25

24 http://www.education.gov.uk/childrenandyoungpeople/send/b0075291/green-paper 25 A new single assessment process and Education, Health and Care Plan is also being tested by the SEND pathfinders

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Personalisation in the round

Whilst personalisation can deliver definite gains in terms of improved outcomes by devolving budgets down to, or close to individual children and families, it has much wider ramifications. Unless services that are funded outside of personal budgets are also personalised and all of those services are redesigned to enable people to make best use, and further develop, their individual capacity and social capital the full impact will not be realised. Figure 4 illustrates how personalisation needs to be implemented ‘in the round’26.

Individualised purchasing

Building and utilising individual capacity and social capital

Personalisation of targeted services outside of individual budgets

Personalisation of public and commercial universal services

BHLP and individual budgets

Integrated service pathways 21st century

schools

Figure 4: Personalisation in the round

Targeted services outside of individual budgets – many of the targeted services on which children and their families draw, for example in health, housing, employment and leisure are provided outside of children’s services and lie outside of the funding provided for PBs. Examples of personalisation are the development of integrated service pathways that are person rather than service centred.

Universal services – more is spent on universal than targeted services. But these are often designed for the ‘average customer’. This means special arrangements have to be made for many people to be able to access these services. Personalisation seeks to address this inequity by both opening up universal services to all and ensuring these services cater for a range of needs. Much development has already

taken place within universal services27 but seldom is it all brought together in one place and implemented as part of a cross-sector approach to personalisation.

26 ‘Personalisation’, Clive Miller, OPM Public interest briefing, 2010 www.opm.co.uk 27 ‘Personalisation of universal services: 1. Bus travel’, Clive Miller OPM, 2010 and ‘Personalisation of universal services: 2. Library and information services’, Clive Miller OPM, 2010 at: www.opm.co.uk

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Schools are a good example. Schools, in common with other organisations, have either an implicit or explicit (e.g. home-school contracts) contract between themselves and the children who are their pupils and their families (see Table 4).

Table 4: Primary school: partial example of the home–school implied coproduction contract

School Pupil Parents

Provide a full day of stimulating education

Be alert and engaged throughout the day

Ensure your child has a good night’s sleep

Enable children to become functionally literate

Be able to communicate verbally and in English

Talk and read to your child in English

Provide affordable lunch time meals

Not be distracted from learning because of hunger

Ensure your child has a good breakfast

Maintain an orderly and collaborative working environment

Be aware of own behaviour and its impact on others; have and use collaborative skills

Set boundaries for behaviour and encourage collaboration

Require pupils to wear school uniform

Wear clean and presentable uniform

Buy uniform and clean it regularly

Whilst many children and their families are able to fulfil their part of the contract others who through poverty, lack of suitable accommodation or homelessness, disability or illness cannot. It is here that differentiation of the school curriculum and providing a range of support through their extended school programme schools can reshape their universal offer to meet the full range of children’s and families’ needs.

This approach needs to not only be applied in an ongoing way in all schools but also in all of the other public and commercial services on which children and their families rely. This is the approach now enshrined in the concept of the 21st Century School28 (see below).

Table 5: The 21st century school

Key features

Excellent personalised education

Contributes to all aspects of well being

At heart of preventative system

Committed to multi agency working

Collaborates with other schools and colleges

Seeks active partnership with parents through initiatives such as Achievement for All29

Resource for families and the community

Engaged with the Children’s Trust

28 Your child, your schools, our future, DCSF, June 2009

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Individual and social capital – enabling ‘self-directed support’ helps people to make best use of their own resources and is a requirement for the effective use of PBs.

It enables people to look at how they would like to live their lives, what they and others can do to realise their ambitions and what support they need to do so. This approach is central to enabling people to be active citizens.

But we need to overcome the problems of universal services that are not open to disabled children and others, and streets that are actually or felt to be dangerous as they inhibit the development of effective social networks and reinforce social isolation. This is not a task that children’s services can or ought to tackle on their own. Others are far better placed but require the active collaboration of children’s services to ensure the desired impacts for children and their families are realised. Health and wellbeing boards will be key to ensuring this collaboration as the forum for local commissioners across the NHS, public health and social care, elected representatives, and representatives of Health Watch to work together to better the health and wellbeing outcomes of the people in their area. See: Health-and-wellbeing-boards.

Gloucestershire County Council are learning from Asset Based Community Development as an approach, and developing commissioning at locality level between families, multi-agency locality teams and providers. This is intended to encourage the development of partnerships between professionals and families, to promote the role of disabled young people and families in finding solutions and creating opportunities and to promote a recognition of disabled people as active and contributing citizens. Contact: Alison Cathles, Lead Commissioner for Disabled Children and Young People Alison.cathles@gloucestershire.gov.uk

See also In Control’s work on Real Wealth30 and Think Local Act Personal’s work on

community capacity building31.

Prevention – All children and their families, not just those children with additional and complex needs, can benefit from personalisation. Personalisation supports primary prevention through ensuring that all universal services are designed to fit the widest possible range of needs and actively work with children and families as co-producers of outcomes.

29 http://www.afa3as.org.uk/ 30 http://www.in-control.org.uk/news/in-control-news/new-paper-volunteering-unlocking-the-real-wealth-of-communities.aspx 31 http://www.thinklocalactpersonal.org.uk/BCC/About_BCC/

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Newcastle City Council has used the early intervention grant to support short breaks to disabled children by developing an inclusive network of cultural and sports providers.

They have funded hubs in dance, sports, music, and art and a social inclusion club for children with autism. They call this programme get connected . It means in practice that a connection to a community activity for a family is just a phone call away. If the family phone their dance hub Jambalaya for example, staff at Jambalaya will find a low cost dance class for their child which will take into account their child’s disability and help them be successfully introduced to the class, there will also be an opportunity to join the integrated dance troupe Inclusive theatre.

If a child is interested in music the Sage Gateshead will either invite the child to join their integrated band or link them to a community musical activity. This approach works by funding staff within the cultural or sporting hub to connect children to inclusion. Last year 100 disabled children became connected to ongoing inclusive community activities.

Contact: Martin Donkin, Project Manager martin.donkin@newcastle.gov.uk

At the secondary prevention level, children with additional needs will also benefit from input from targeted as well as universal services. The targeted mental health in schools pathfinders32, demonstrated that boosting the capacity of schools and other universal services to meet children’s needs was a more effective way of delivering outcomes than direct work with children and their families. Children with additional needs who require support from a number of targeted services can benefit from the use of devolved budgets.

Experience shows that PBs can be used to greatest effect where parallel work is being carried out on personalising universal services and targeted services so that all services are designed to make best use of, and build on the capacities of, children and their families and their social networks.

32 Learning from the Targeted Mental Health in Schools Pathfinders: summary report, DCSF, 2009

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Darlington Borough Council's Draft Learning Disability Strategy 2012-15. The main outcome of the strategy is to support those in need of social care to maintain their "citizenship" rather than statutory services replacing individual support networks. The Community Strategy plays an intrinsic role in supporting the idea of citizenship, in particular of ensuring the quality of this citizenship. See: Learning Disability Strategy Contact Mark Humble, Strategic Commissioning Manager, Mark.Humble@darlington.gov.uk

Durham Council are developing a Community Consultancy Model including building on work from Australia focused on the mental health of men - men's sheds http://www.mensshed.org/home/.aspx

Key points:

1. Understand personalisation – the child and their family in the driving seat in terms of making decisions about what will work for them; families enabled to make active use of their own resources and capacities as well as drawing on service support as required.

2. Ensure Health and Wellbeing Boards provide leadership and the strategic drive for personalisation across children’s services

3. Focus on the child and family’s whole life rather than one aspect of it; focus on the key outcomes to be achieved

4. Provide awareness training for families and staff about personalisation; follow this up with supervision, challenge, coaching and sharing experiences

5. Personalise services that are funded outside of personal budgets

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Understanding ‘needs’

We said at the start of this guidance that the first key stage in the commissioning process is ‘understand’.

The more comprehensive the ‘needs’ assessment is, the more likely that commissioning practices can:

Address frustration and misunderstandings for children, young people and their families

Improve information sharing and communication across children’s services

Improve relationships between commissioners and providers

Support service planning for population groups and enable personalisation

Deliver services that actually work for children, young people and their families.

Joint strategic needs assessment (JSNA) was introduced in 2008 to create stronger partnerships between communities, local government and the NHS, providing a foundation for commissioning that improves health and social care provision and reduces health inequalities. It was intended to help commissioners shape services to address local needs, and a number of supportive resources have been produced to help local areas undertake their JSNAs.

CSP’s Commissioning for outcomes and efficiency delivering better outcomes for disabled children33 includes “top tips” from commissioners on completing JSNAs including:

i) Map your data sources, then investigate and interrogate the data

ii) Complement your hard data with experience data.

It includes exemplars such as the City of Bradford and Durham County Council’s work to improve the way they complete their JSNAs including how they involved families in the process.

CSP developed tools and guidance to support local areas to commission speech and

language therapy services including understanding need34.

Health and Wellbeing Boards will be responsible for undertaking the JSNA which will be a vital tool to support the boards to understand the needs of the whole community, and agree collective action to address these needs. See DH’s JSNA and joint health and

wellbeing strategies explained, Dec 201135. This document includes a helpful explanation of how the commissioning cycle, JSNA and joint health and wellbeing strategy fit together (see figure 5 overleaf).

33 http://www.commissioningsupport.org.uk/pdf/42_disabled_web_22nov10.pdf 34 http://www.commissioningsupport.org.uk/the-commissioners-kitbag/about-the-kitbag.html 35 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131702

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Figure 5

Understanding the present system and what is available – mapping

There is a need to identify and map all provision within the local service system, regardless of provider. A vital role for commissioners is to understand current services, how they are used and the outcomes they achieve. Information about the effectiveness of services should include reliable feedback on outcomes from service users.

Given the wider scope of goods and services that people with PBs may want to choose from mapping should extend beyond existing services. It should include services that are easily accessible to children and young people but which are not currently procured by the local authority or NHS

Given that changes may be made in service configurations it should include the nature of the commissioning and contracting arrangements for each service. Where in-house services are commissioned their scope and an indication of the time it would take to change, increase or decrease them should be included. All contracts with external organisations should also be mapped highlighting any penalties that might arise as a result of variation

The SEN Pathfinders are tasked with testing out the development of a local offer of services which will clarify what support is available and from whom. In Support and

Aspiration: A new approach to SEN and disability Progress and Next Steps36 the Government confirmed that local authorities will be required to set out a local offer

36 http://www.education.gov.uk/childrenandyoungpeople/strategy/laupdates/a00209060/support-and-aspiration-a-new-approach-to-special-educational-needs-and-disability-progress-and-next-steps

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which offers information for parents, in a single place, which helps them to understand what services they and their family can expect from a range of local agencies – including their statutory entitlements; and makes clear what provision is normally available from early years settings, schools (including Academies and Free Schools), colleges and other services, including health and social care.

The local offer will:

Cover provision for children and young people from birth to 25 and include education, health and social care services.

Provide accessible information on services and provision that children and young people who have SEN or are disabled and their families and carers can readily access or expect (for example special educational provision that is normally available in mainstream schools and colleges from the resources available to them, and short breaks for families of disabled children).

Set out how families and carers and where appropriate, young people, can seek access to more specialist support than is normally available and how decisions are made about provision of that support, for example assessments for Education, Health and Care Plans.

Set out what to do if things go wrong, including how to complain or appeal against decisions.

The Evaluation of the SEND Pathfinder Programme quarterly report March 2012 suggests that local areas are approaching the local offer in one of two ways: a high level offer to families setting out how agencies will work together or the creation of a provider based

resource. 37

You may find it useful to distinguish services as follows:-

Universal level – These are public facilities and services that are available to all children and young people or which children and young people may access such as parks, playgrounds, schools, GPs, libraries, leisure centres, and children’s centres. In some places the management of public facilities is being transferred from local government to community groups and they may need to be reminded of the importance of an inclusive and personalised approach to service delivery.

Especially at the early stages of diagnosis much of the advice and guidance for parents of disabled children comes from universal services. Staff in universal settings will need support to ensure they are providing the best possible environments for early diagnosis and advice and thinking in a personalised way from their first contact with families.

Targeted level – These are services for children who may have a particular need for specific services over and above the universal offer. In some areas of high deprivation targeted support may be necessary on a ‘universal’ basis, i.e. available to all or almost all children and young people. Support will need to be provided in addition to the universal services and may require specific training and additional workforce. Children should by

37 http://media.education.gov.uk/assets/files/pdf/s/evaluation%20of%20the%20send%20pathfinder%20programme%20quarterly%20report%20%20%20march%202012.pdf

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definition move in and out of targeted provision, so it is important to ensure good pathways back to universal and up to specialist tiers of support.

Specialist level – These services will support those with particular needs over and above those that can be met by universal and targeted provision. They will include access to a range of support in different settings, adaptations to existing universal settings such as extra facilities in schools, appointment of a learning support assistant or worker to accompany a disabled child to after school clubs, and access to specialist support including physiotherapy and speech and language therapy. Children and young people requiring the specialist tier of support will continue to benefit from universal and targeted interventions and again it will be important to ensure good pathways.

It is helpful to understand that a child with specialist level needs for one condition may also be using targeted support for another. This is well illustrated with reference to speech, language and communication needs as follows:

A child with otherwise complex additional needs may not have specialist speech, language and communication needs, and these needs may be met at the targeted level of provision.

A child with a specific language disorder who has good general learning ability and no other concomitant special educational or medical needs, might appropriately be considered as part of the specialist tier in respect of speech, language and communication needs, whilst otherwise being thought of as in the targeted tier of need.

Speech and language therapists, who are by definition ‘specialists’ in speech, language and communication within the workforce, have a specific and differing role to play at all three tiers of provision, universal, targeted and specialist.

It is important to note that there will be a range of types of support needed by children, young people and families across all tiers and that some professionals, specialist

therapists and roles will be providing support across all levels.38 39

Information can be collected and analysed in any number of ways but a mapping template is a useful tool with which to do this. For example a suite of templates is available for speech language and communication services within the Balanced System™ framework (Gascoigne, 2008)40. These templates map provision, the workforce which delivers provision, the funding source and the contribution of the provision to speech, language and communication outcomes for children, at universal, targeted and specialist tiers. In addition there are specific templates to map training and advice provided to parents, carers and the wider workforce.

Understanding cost and value

Commissioners need to understand the cost and value of services which support children and young people. They may need to analyse costs from all three of the following perspectives:

38 Tools for commissioning better outcomes www.commissioningsupport.org.uk/pdf/SLCN_intro.pdf 39 See also www.thecommunicationtrust.org.uk 40 This can be accessed at www.mgaconsulting.org.uk/the-balanced-system.

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top down costing of the whole system – to understand where resources are currently being used and to enable them to make plans to move resources from one part of the system to another as well as rationalising budgets. For example to understand the amounts of money which are being used by particular groups of children at different ages or with different levels of need

bottom up costing41 – case by case – to calculate the total cost of a service or a group of services for one child

service or system costing - for example using the costing spreadsheet developed by Together for Children for children’s centres; this costing tool can be adapted for

different uses42.

Assessing value is much more difficult. Ideally this should be based on outcomes data relating to individual elements of a service enabling an assessment of value for money of individual components. More expensive services do not necessarily provide the worst value for money if they are highly effective. Where various services contribute to an outcome, it may not be feasible or even meaningful to disentangle the contribution of individual services. However, it may be possible to make value for money comparisons where different elements in the service are providing the same outcome in different ways. It will be essential to refer to wider research on the effectiveness of different types of

provision43 44. This issue is further covered in ‘review’ below.

Quantitative data may also be required; much of this will be collected to inform the JSNA. However, it may be useful to have information about the children, young people and families who are accessing, or not accessing, the mapped services in terms of both numbers and demographic information. This will allow a greater depth of analysis.

Precise measures which will be useful will be locally determined but the following measures may be helpful to consider (not all will be appropriate across all tiers of services):

access arrangements, for example, open access, by referral only

numbers of children, young people or families accessing services

age, gender, ethnicity and location of those accessing services

referral and/or access source/s to the service if appropriate

referral numbers to services by the source of referral where it is a referred service

average waiting times for services where appropriate

rate of non-attendance

41 See Costs of Short Break Provision 2010, Holmes et al http://www.lboro.ac.uk/research/ccfr/Publications/Cost%20of%20Short%20Break%20Provision.pdf and Unit Costs:not exactly child’s play Beecham, Jennifer, 2000 http://www.pssru.ac.uk/pdf/B062.pdf 42 https://www.nationalcollege.org.uk/costing spreadsheet 43 The DCSF and the DH has commissioned the Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, to deliver a research programme on the cost effectiveness of speech language and communication services. At the time of writing nothing had yet been published. See http://www2.warwick.ac.uk/fac/soc/cedar/projects/current/slcn/ 44 See also the Centre for evidence and outcomes http://www.c4eo.org.uk/

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outcome indicators for services including different elements of services

relative costs e.g. per hour/overnight

user evaluation measure/s for services

unmet need

All data will need to relate to the same timeframe (for instance, the same financial year).

Note that once the system has been transformed into one where personalisation and PBs are the norm the system for gathering information together to find out what services people find effective and are using should be much improved. In places where the CAF, lead practitioner, single plan and team round the child system is fully established commissioners find they have a much more accessible and useful data set at the end of each year on which to base their future plans for commissioning existing and new services.

Benchmarking information

In order to discover how a system is performing in comparison to others it will be important to benchmark data with other places. This can be done by:

reference to benchmarking club information or published performance information

reference to robust published research such as that collated and published by C4EO

see: C4EO45 and audit commission data46

discussion with other local authorities and organisations

feedback from service users, parents/carers and others

As systems are personalised feedback from families will be available through review of single plans and aggregated data because they are informed by parents and children who are part of the planning and review process throughout. In the interim, it may be necessary to conduct surveys or otherwise collect and analyse user experience and opinion about services received.

Sources of feedback may include interviews and focus groups with children, young people and their families47, together with additional information derived for example, from:

case file reviews to explore the impact of services on the needs and outcomes for children, young people and their families

data from ongoing user surveys, exit interviews, the complaints, comments and compliments system

analysis of some performance indicators or recent service inspections or reviews

45 http://www.c4eo.org.uk/themes/disabledchildren/default.aspx?themeid=2&accesstypeid=1 46 Personal Social Services Research Unit (PSSRU) Compendium of unit costs – this is completed annually and includes health and social care costs http://www.pssru.ac.uk/archive/pdf/uc/uc2011/uc2011.pdf 47 See case study examples on the Commissioning Support Programme website such as Children’s Participation in Shaping Service Models, London Borough of Newham http://www.commissioningsupport.org.uk/resource_bank/case_studies4658.html?page=2

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discussion with professionals and advocates working with service users on their views of the service user experience

inviting and empowering children and young people and their families to be involved in the quality assurance of services.

Pass It On Newcastle

This project evolved out of the authority’s Family Information Service (FIS).

The aim was to develop the website so that it became the place of choice for information and advice for parents and carers – an aim they feel they have now achieved.

So how did they get there? In order to understand families’ perception of FIS, Kate Fulton from Paradigm was employed to talk to families about what kind of advice they were looking for and the best way for them to receive it. Families were asked their views, using a standard questionnaire. The questionnaires were circulated via the disabled children’s register and Survey Monkey; additionally Kate went to all the places families go including mainstream and special schools, mother and toddler groups, early years services, physiotherapy groups, fun days etc distributing the questionnaires as she went.

One of the questions parents were asked was ‘what is the best bit of advice anyone has given you’? Answers to this question indicated that families particularly valued advice and support which helped them to realise they were not alone, to see the positives in their child and that supported them to stay strong. They also particularly valued and trusted the information and advice that was given by other parents rather than professionals. .

In response to this finding parents were subsequently asked an additional question – would you be willing to help one other family if they thought it would be helpful? Not one family said no to this question. The Pass It on Network was born.

In the beginning 12-15 parents, who previously didn’t know each other became involved - parents who had stated in response to the questionnaire that being in contact with another family would have made a significant difference to them. The group of parents set about developing a mechanism of pass it on parent which enabled parents to help each other without requiring them to join the group. Parents volunteered to help one other family and to stay connected to other groups such as special schools, baby and toddler groups etc they were already involved with. They also committed to passing on relevant, useful information to FIS. Families have become passionate about information, and feedback information about both specialist and universal community services.

In order to check they are reaching all parts of their area, pass it on parents are completing a mapping exercise of providers across the area to check their parents are linked to all formal and informal networks from bakeries to local community groups. They have also set up a facebook page, pass it on Newcastle, which they administer themselves and which now includes helpful tips which professionals can also contribute.

A continuing challenge for the families is how to make feedback and quality assurance valuable enough to providers so that it matters to them? They are looking at this as well as how to involve children and young people more in the quality assurance process.

For further information contact: Kate Fulton, Senior Consultant, Paradigm 07791 035129 kate@inclusionnorth.org

Also see Pass It on Newcastle on Facebook

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Understanding outcomes

All decisions should be based on improving outcomes for children, young people and their families, with a clear rationale based on robust analysis and evidence. This focus on outcomes runs through all aspects of the commissioning process.

In the course of their work commissioners need to learn about what works to improve outcomes and help create a culture which nurtures innovation, where this is required, and self-learning across the children’s system.

The SEND Pathfinders are developing new outcome measures, building on the Every Child Matters Outcomes. The South East Seven (SE7) Pathfinder has, for example, agreed to use to be safe, to be as healthy as I can and to achieve as the three outcomes

they are working to achieve for all children and young people.48

See also procurement techniques in ‘do’ below.

Key points:

1. Ensure your local joint strategic needs analysis (JSNA) includes detailed information about the needs and unmet needs of disabled children and young people and their families

2. Map all provision within the local service system, regardless of provider; understand how they are used and the outcomes they achieve; include reliable feedback on outcomes from service users

3. Health and Wellbeing Boards will be responsible for undertaking the JSNA and using evidence from it to understand the needs of the whole community, and agree collective action to address these needs

4. Use the requirement to develop a local offer to extend mapping beyond existing services

5. Understand the real cost of in-house and externally commissioned services and the outcomes they achieve

6. Benchmark in order to provide further challenge

7. Maintain a focus on outcomes through each stage of the commissioning process

48 http://www.se7pathfinder.co.uk/

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2. Plan – stage two of the commissioning process In order to understand stage 2 we need to explain the three levels of commissioning because each has responsibility for different sorts of plans and input into policy and system standards. It follows that each level has different governance and involvement of stakeholders including service users and their families in decision making.

Personalisation and PBs greatly extend the leverage that children, families and front line staff have over resources. These developments effectively devolve control over the use of resources to the front line and empower children, families and front line staff to operate as commissioners of services. This requires a change in the way commissioning is conceived and practised from a top down strategic level activity to one where commissioning is driven directly by and with children and their families and enabled by strategic commissioning.

Figure 6 Multi level commissioning

Individual level

Individual level commissioning comprises PB holders, support brokers, key workers and lead professionals. It incorporates supporting children and families to make best use of their existing resources and social networks and to further develop them as well as extending the range of available services.

Operational level

The culture and practice change required to facilitate self directed support does not occur overnight. It needs to be organised to provide continuing support to children and families, front line staff and service providers so they can work together in a new way. Much of the personalisation of universal and targeted services that lie outside of the range of devolved budgets can be achieved through operational level changes within existing contracts and service level agreements. The development of multi agency teams and networks to support wider service integration provides a base for this. For example, Scotland has

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developed the role of the local area coordinator49 following a recommendation in ‘The same as you?’ review of learning disability services in 2000. The review said that health boards and local authorities should appoint local area co-ordinators with a specific brief to

work alongside communities to support them to become more welcoming and inclusive.50

Operational level commissioning can:

develop the capacity of the multi-agency workforce to support children, young people and their families or carers to use their own resources, devolved budgets and existing targeted and universal services in creative and flexible ways

take the lead in ensuring that appropriate funding agreements are in place so that the child and family can make best use of flexible funding options to access the support they require, for example, where a child is receiving a package of support jointly funded by a local authority children’s services department and a primary care trust (or CCG from April 2013)

help local communities to develop informal systems of support

enable local providers to review their current service delivery practice; and challenge and support them to develop a wider, more personalised offer to children, young people and their families or carers

devolve commissioning powers to local teams and networks to reshape and personalise some local services, taking into account the needs of specific populations or geographic situations.

Strategic level

There are some activities that can only take place at a strategic level, for example, overall planning, and others where there are advantages in doing so, for example the production of explanatory materials for children, families and staff.

Strategic level commissioning activities include:

redesigning children’s services to simplify the system, reduce fragmentation, duplication and internal transaction costs – for example creating operational teams to bring together special education and disabled children practitioners, setting up integrated locality teams (whatever they may be called) to bring together all the additional and targeted services for children and young people under a single manager

common infrastructure – developing and maintaining the systems and processes required to support the operational level management of self-directed support (including for example the CAF process)

common principles – establishing common principles for personalisation, self-directed support and community development and supporting their implementation at both the operational and strategic levels of commissioning

49 ‘Local Area Coordination’ in, In Community: practical lessons in supporting isolated people to be part of the community, Carl Poll et al ed, Helen Sanderson Associates and In Control, 2009 50 http://www.scld.org.uk/local-area-co-ordination/what-local-area-co-ordination

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devolving commissioning powers and empowering operational managers to commission services jointly

developing a resource allocation system – see below

involving children and families and operational level commissioners in all stages of strategic level planning, prioritising and implementing changes in universal services and in targeted services that fall outside of the range of devolved budgets

pooling or aligning budgets across sectors so that personalised options and pathways can be developed that do not fit easily into the funding remit of any one sector

ensuring that self directed planning and purchasing support is available including making available a range of support brokerage services. This may include money management options and ensuring that families and carers are aware of and have

access to this support. See In Control’s fact sheet on support brokerage51

Newcastle personal budgets pilot

Newcastle has run a successful 3-year personal budgets pilot for children and young people. They have contracted with Skills for People, an advocacy project to provide support planning and brokerage.

Skills for People have also been contracted to coach and mentor other VCS organisations interested in offering support. For further information contact Martin Donkin, Project Manager Individual Budgets Children’s Social Care - 0191 2774700 martin.donkin@newcastle.gov.uk

scaling up finance infrastructure to handle significant numbers of small payments …

market management – working with children, families and providers to enable providers to develop the range of personalised services that devolved budget holders wish to purchase and to reduce or stop providing services that are not wanted – see procurement techniques to support commissioning below

information – making information easily accessible and relevant to children, young people, families and those supporting them. See for example Suffolk’s “Activities Unlimited” which won the MJ Achievement Award for service innovations in health and

social care in 201052

quality assurance – giving families and carers a chance to choose from ‘quality’ services and support options; involving children and young people and families and carers in identifying quality services and support options . Examples of good practice

51 http://www.in-control.org.uk/media/16711/06.%20support%20brokers%202011%20v1b.pdf 52 http://www.activities-unlimited.co.uk/Public/StaticContent.aspx?contentID=Activities_Unlimited_home_page

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include You’re Welcome Quality Criteria for young people’s health services.53 See also Newcastle’s Pass it on parents above.

In North Tyneside 6 families received PBs using Aiming High, carers grant and social care funding in 2010/11. This improved partnership working between families and professionals. Building on work done by Middlesbrough the authority used a RAS comparator price point to determine funding levels incorporating both the child and family’s needs.

Families used their budgets in creative ways for example to commission family activities such as a family football season ticket and equipment (play and IT). Key to this success was training to ensure social workers and families understood effective person centred planning. Key too was the provision of advice and support to parents/carers from a locally based authority commissioned not for profit organisation to support the employment of workers. Social workers monitored outcomes for disabled children and their families and the performance of IB’s.

Children services are now including tapering in their local authority commissioned contracts (building on work started by adult services) with the aim that services will become self-sufficient within 3 years.

A survey has been recently been carried out with over 50 families to find out from them who they would wish to be their key worker and in response North Tyneside are planning to build on this evidence, as well as their experience from Early Support, to extend key working to other professional groups from across education and health and parents/carers.

Strategic commissioners are working with the children with disabilities team to support consultation work with parents/carers and children including the development of their short breaks statement. Whilst the direct payment and individual budget team monitor financial arrangements, commissioners are working with them to develop a tool which will enable the team to model and forecast costs given the sheer number and complexity of commissioned services.

Commissioners are also supporting the team’s negotiations with providers locally and regionally to improve contracting including monitoring of outcomes and costs.

For more information please contact Anne Cassidy Anne.Cassidy@northtyneside.gov.uk

53 81% of commissioners have recommended that local services implement the guidelines. As part of this local leadership, 64% are involving young people in rating and evaluating experiences of health services. The guidelines can reinforce young people’s social responsibility as life-long users of the NHS and encourage them to share in the decisions made about their health DH Website May 2011 See: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126813

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Strategic commissioning – basic roles and responsibilities

The strategic commissioning function is shared between ‘governors’ (partnership members of the Health and Wellbeing Board and children’s partnership board) and executive commissioners including the Director of Children’s Services (DCS). Many children’s systems encounter problems because they do not fully understand this separation of powers and functions and the benefits of good governance.54 Good governance needs to be supported with excellent information compiled into reports which aid decision making and this is the job of the DCS and /or the director of commissioning together with commissioning leads from partner agencies – the NHS and perhaps housing and police commissioners. People from the strategic commissioning team within the local authority including the director of public health would also be involved.

The prime focus of the strategic commissioning board (or Health and Wellbeing Board) is to agree strategic plans, policy and standards for the whole system and as part of that to make the best possible decisions about the future of the whole system so that it improves the lives of children and young people. They will need information about how the whole system is working to improve outcomes for the whole population as well as for particular groups of children with particular needs and/ or in particular locations or situations. They will need to be very clear about what powers – particularly for operational level commissioning they are delegating to operational commissioners (most of whom will also be providing services) and what they expect from them in terms of outcomes for children and young people as well as performance information.

We describe below how disabled children’s services are included in ‘must do’ standards, policy and strategic plans. In regard to typical structures and governance the following would be a good approach and is now not uncommon.

There is a lead commissioner for the disabled children’s system in the strategic commissioning team. This team works closely with the DCS (as lead commissioner for the system). S/he reports directly to the children’s partnership board on the performance of the system in relation to disabled children and young people. (The children’s partnership board is accountable to the Health and Wellbeing Board) S/he writes those parts of the strategic plan, annual budgets, commissioning policy and must do standards taking into account the performance of the system in the previous period, the experience and opinions of service users and other stakeholders, evidence of what works to improve outcomes and so on.

The lead commissioner for the disabled children’s system may choose to establish and support a subsidiary partnership board where parents and young disabled people and perhaps providers of services (in-house, VCS and independent) can contribute to developments and enhance stakeholder engagement in strategic decisions. It is good practice to have parent/carer and service user representation on the main strategic commissioning boards. The lead commissioner for the disabled children’s system may have a small team and between them they are responsible for managing the relationships and the performance within the system so that public money is used in the best possible way.

54 Reference to the CSP learning together report on children’s trust governance and the good governance standard for public services published by OPM,CIPFA, JRF in 2003 and available on www.opm.co.uk

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Joint commissioning for services for disabled children is not uncommon and so co- location of PCT staff and sometimes aligned and pooled budgets are managed by this team together. Where the system is personalised and there are personal budgets the information obtained from individual plans and reviews as well as from service providers will inform commissioning decisions across the system.

A major responsibility of the lead commissioner in such a system is calculation of and agreement of the resource allocation system (RAS see below). In addition, arguing for a fair share of resources for disabled children and young people, managing the overall budget and clearly delegating parts of it to operational commissioners and service providers so the system works optimally.

‘Must do’ standards for whole system – or commissioning principles

These need to be agreed by the Health and Wellbeing Board and children’s partnership board after consultation. Agreement and review of these is part of the annual calendar for strategic partnership boards. Many children’s partnership boards have agreed ‘must do’ standards which they require of /expect of all those working with children and young people in their area. These must do standards form part of the strategic plan and are used as a preamble to contracts and service level agreements and other arrangements including schools. They therefore have to be developed in consultation with all stakeholders.

Typically “must do” standards include safeguarding, equality of opportunity, treating children and parents with respect, providing as much continuity of key relationships as possible, working appreciatively and aspirationally with them and taking into account their views when making decisions (no decision about me without me55) 56.

In many places they now also include a requirement to ‘work with us to establish personalisation and PBs for all children with additional and specialist needs/for disabled children.’ Some now include a more demanding requirement ‘to respond to the demand for a PB from disabled young people and or the parents of disabled children and young people by acting as the lead broker/budget holding key worker if chosen by the young person/family, to support and attend team round the child meetings, to use and implement a single plan, to participate in working with others to support the child or young person and to review his/her progress against the single plan’.

Examples of other ‘must do’ standards can be found in OPM’s publication on integrated commissioning57. These ‘must do’ standards are clearly easier to implement if they are kept short and simple and are enforced as the norm across all children rather than just for a particular group of children.

55 The NHS requirement 56 Some people use the golden threads identified in the ‘Narrowing the Gap’ publications and subsequent work done by C4EO and available on their website 57 Integrated commissioning for children’s services. A practical guide to the development of simple commissioning frameworks and clear structures for children’s services authorities J Smyth Dec 2007

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Commissioning policy

The children’s partnership board needs to agree a commissioning policy; agreement and annual review of this is part of the board’s annual duties. A commissioning policy describes the local authority and its commissioning partners’ policy which will guide everyone in the system about how they choose which providers to work with to provide services and how to choose them. It is likely to include some or all of the following:

outsourcing – the make or buy decision. In some places leading politicians are clear that services should be outsourced; in others there is a clear political steer to retain services within the local authority whilst ensuring they are better able to demonstrate contestability and run themselves more like separate business units than before

how they will demonstrate contestability and when competitive tendering might be used

the policy regarding contracting with different sorts of organisations; there may for

example be a policy to favour the VCS58 and/ or social enterprise/mutuals over others

policy on integration and co- location of certain services with the NHS

corporate policies that apply to children’s services such as reducing the carbon footprint, creating and retaining local employment to improve the local economy, sharing the use of public buildings, high customer service standards, expectations around public engagement and more.

Strategic plan

Although the DfE no longer require authorities to produce an agreed children’s plan most DCSs have continued to do so. The best have developed a new generation of plans that move beyond a description of needs and a list of priorities to include plans for change (including inevitably for reduced budgets but at least this approach enables consultation on these decisions). Discussion in the children’s partnership boards of these authorities are much more strategic than before and include:

consideration of the whole system challenges of mainstreaming personalisation, PBs and resource allocation

debates about inequality and poverty focussed on the universal offer (rights) and on what parents/carers need to do for themselves leading to local policy about the role of the local authority and the best use of reducing public resources

knowledge about the allocation of resources across localities and groups of children and an ability to package groups of services more strategically (all youth services rather than the previous plethora of pilots and programmes) and to move resources from one part of the system to another

58 A better way? The impact of commissioning on the children and families voluntary sector, Children England http://www.childrenengland.org.uk/upload/Commissioning%20a%20Better%20Way%20Full%20report%20with%20summary.pdf

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more awareness of how the system works for different ages and stages and more accountability for early years handing over cohorts of children more or less ready for school, and likewise the primary stage more or less ready for secondary school etc

strategic, costed and evidence based decisions for example about prevention and early intervention and reduction of numbers of children in care or in high cost unsuccessful residential schools

closer work with adult care commissioners (the health and wellbeing board in future) and providers leading to the development and agreement of a better approach to transition

plans for change – for example system redesign, service, change, service growth, service closure – in other words re-commissioning the system and services

The Commissioning Support Programme supported local authorities and their partnerships to develop children’s strategic plans. After considering all the issues and the parts of the system which needed to be improved and/ or radically changed this, in most places resulted in a chapter devoted to redesign of the system for disabled children, young people and their parents, written in the context of the strategic priorities and policies of the children’s partnership.

In the best places this was focussed on the changes needed to embed personalisation and went into some detail about the change plan to enable the system to change from where it is now to approach the agreed vision for the system driven by personalisation. Parents/carers and children and young people were involved as were service providing teams within the local authority and NHS and VCSs.

As a result the plans for change are clearly understood and ‘owned’ by those who will be affected by them. Where it is agreed there are important changes to be made in the disabled children’s system there are opportunities during the year for further reporting and discussion at the strategic commissioning partnership so there is early input into the plan that eventually forms part of a new style children’s plan.

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Gloucestershire County Council developed a commissioning strategy to transform support and outcomes for disabled children and young people in 2007. The strategy was developed by parent carers and professionals from a range of services, informed by young people. Gloucestershire County Council’s 2007 overall vision was to ensure that within 10 years:

In terms of the achievement of Every Child Matters outcomes, there are no differences between disabled and non-disabled children and young people

All disabled children and young people are able to access the same opportunities, community activities and mainstream services as their non-disabled brothers, sisters and friends, with additional support if necessary, and receiving specialist services where this is the most effective way of meeting identified needs.

All staff in mainstream services are confident and able to work with all disabled children/young people apart from those with the most complex of needs

Children/young people and families are in the driving seat in the development of services and removal of barriers for children and young people with disabilities.

Statutory services build on the strengths and abilities of children and families rather than focusing on what they cannot do and where they are failing to cope.

Young people move smoothly into adulthood with changes in support services planned and known in advance.

The Council has recently reviewed the strategy and agreed that whilst the 10-year vision is still relevant, it needs to be expanded to more explicitly embrace education and health outcomes, and give a stronger emphasis on an entitlement to citizenship.

Contact: Alison Cathles, Lead Commissioner for Disabled Children and Young People alison.cathles@gloucestershire.gov.uk

Annual budgets and plans

The fourth and last function of the strategic children’s partnership board is to oversee the translation of the strategic plan (usually a three year rolling plan) into business plans for the system and the budgets available. One of the problems in some places over the last few years is children and young people’s plans have been very poorly linked to the budgets and ‘business planning’ cycle and therefore difficult to implement.

In regard to services for disabled children and young people the process could go something like this:

1. plans for change agreed

2. system redesign (to reduce numbers of projects, programmes and pilots and therefore transaction and management costs) results in repackaging services and therefore a need to cut the budgets in different ways; this may include alignment or pooling of budgets with key partners especially the NHS - joint commissioning is established

3. resource allocation systems resulting in needing to cut the budget in different ways too

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4. budget negotiation and agreement based on different assumptions and different income and expenditure streams

5. business plans of service teams within the local authority are fully costed and comparable with the business plans of external contractors – all are clear about the contribution they are making to the system and the impact and contribution to outcomes they will achieve for service users

6. DCS/lead commissioner for disabled children’s system presents summary budget and business plan to children’s partnership board for agreement (particularly to check they are in line with the change plans agreed earlier) before sign off at the full council and PCT/clinical commissioning groups.

Making budgets more flexible to facilitate Individual/Personal Budgets – in Gloucestershire the size of the budget supporting personalised and individually commissioned care packages has increased from £712k in 2010- 2011 to £1,180 in 2012-13, not by increasing the overall budget, but by removing restrictions from budget streams and some decommissioning of contracted services.

Contact: Alison Cathles. alison.cathles@gloucestershire.gov.uk

Key points:

1. Understand the three levels of commissioning – strategic, operational and individual because each has different responsibility for enabling personalisation.

2. Be clear about what powers are to be delegated particularly for operational level commissioning.

3. Develop a disabled children’s strategy and action plan with parents/carers and children and young people which includes a commitment to extending personalisation, co-production and self-directed support and which clarifies the intended outcomes and benefits of doing so.

4. Agree the ‘must do’ outcomes you are expecting delivered by providers.

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3. Do – stage three of the commissioning process The ‘doing’ part of the commissioning cycle is by far the hardest and one which in some places seem to have been relatively overlooked – even though there is little point in commissioning unless it is underpinned by a commitment to improve the system if there is evidence that this is needed.

The following diagram adapted from Kotter’s work on change shows what is needed in order to start an effective change programme and what happens if any of the four components is missing. There is a need for clear vision and leadership to manage the change process involved in delivering a truly personalised system as described in the sections above.

First steps that lead to action

A clear shared vision

Capacity for changePressure for change

What happens if one element is missing?

Bottom of the in-tray

Anxiety & frustration

A fast start that fizzles out

Haphazard efforts &false starts

Figure 7 An overview of the change process – OPM model

The pressure for change and the shared vision are laid out in the children’s strategic plan. The importance of a clear plan of action which follows from the agreement of the children and young people’s plan cannot be underestimated. Very often this has either not been done or has been done by a plethora of sub partnerships running quite small programmes, projects or pilots which has contributed to the fragmentation of the system and added to its internal transaction costs and inefficiency.

There is also the need for an identifiable lead for change who is someone within the system with some authority – for example the lead commissioner for the disabled children and young people’s system. S/he will need to have the support of a very small team and a wider network of change agents across the system.

When implementing plans for change with regard to personalisation and PBs change is needed at all levels in the system as shown in the diagram below.

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Outcomesfor children & young people

Source: DfES

Figure 8 Leading change at all levels

We discussed above the need for integrated governance and strategy. This section focuses on changes needed to processes, systems, skills, culture and behaviours.

Change is never easy and it is helpful to have in mind some models of change and an understanding of resistance to change as well as the stages most people go through when faced with change.

The Commissioning Support Programme has developed training materials to support local systems to implement whole system change. See: CSP training

New systems and processes

As explained in Section one of this guidance (understanding personalisation) there will be a need for new systems and processes. SQW has developed a common delivery model (CDM) which sets out the infrastructure required to facilitate the delivery of PBs for families with disabled children. Their model covers the 4 areas:

Organisational and cultural change

Engaging and involving families

Setting up the infrastructure

Safeguarding and risk management

See appendix 3 for more details.

New systems and processes will need to include:

single assessment

lead professional or key working role

team round the child/family

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single plan

personal budget approach including resource allocation systems (RAS)

This means, for example giving up on old assessment forms entirely so that people have one assessment, one plan and one review process. These can be supplemented to record specialist information but should result in a single process with minimal repetition of the basics. The SEN pathfinders are charged with developing such a system for children and young people with disabilities and SEN from 0-25. Learning from the Pathfinders is available at www.sendpathfinder.co.uk. See for example the South East Seven’s (SE7’s)

framework for assessment and planning.59

Resource Allocation Systems (RAS)

Across any form of personalised budget a key question is the value of resource allocated to each individual case. Resource allocation provides a way of calculating this amount in relation to assessed need.

SQW’s final evaluation report for the DfE on individual budgets for families with disabled children60 states ‘the allocation has to reflect the needs of the individual and the constrained budgets of funders and the resource allocation system acts as a way of balancing these two factors’.

They continue ‘it is also important to note that the statutory duties placed on local authorities mean that the use of a RAS approach can only produce an ‘indicative’ budget. Authorities are then required to ensure that the level of budget allocated is sufficient to meet user needs61, which in process terms is generally confirmed on completion of the associated support package planning stage.

DfE’s IB pilots provide useful learning with regard to RAS systems. Most pilots used In Control’s taking control model, others adapted this system or developed their own.

In Control’s RAS version 5 supports the analysis of needs within the local population of people needing support by using a scored needs assessment, identifying the scores of each percentile of the population and the costs of support for each individual. Initially cost information is drawn from existing care packages, so that an allocation table is produced by connecting the scores from each percentile in the population with the costs at that percentile. Once the system has been operational for some time it is possible to recalibrate the allocation levels using information from people who have control of personal budgets. In this way some of the inequities of traditional funding can be removed

59 www.sendpathfinder.co.uk/foodforthought 60 Individual budgets for families with disabled children – Final evaluation report: the IB process – Meera Prabhakar, Graham Thom, Rhian Johnson, May 2010 https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR145.pdf 61 “The judgement of the County of Appeal in R (Savva) v Kensington and Chelsea makes clear that while RAS schemes may be used as a ‘starting point’ to give an indication of the level of funding which may be required, they cannot dispense with a local authority’s ‘absolute duty’ to meet assessed needs through services or DPs once it has concluded that such services are necessary” from ‘Cemented to the floor by law;’ Respecting legal duties in a time of cuts Steve Broach, Barrister, Doughty Street Chambers

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over time.62 The key point is that a resource allocation system ensures that resources are allocated on as consistent a basis as possible across participating families.

Experience from the IB pilots was that the introduction of an indicative budget at some point in the process is required to enable both families and support planners to form realistic support packages, although they varied on what point this was needed.63

In Control has worked with over 40 different children’s services supporting them to develop allocation models and there are now a variety of models of resource allocation

that can be adopted or adapted by local areas. See for example, West Sussex’s RAS.64

In Control is supporting local areas introducing personal budgets incorporating health and education budgets also.

South Tyneside has been using PBs and IBs in their children’s services for the last few years. Approximately 45 young people receive either PBs or IBs. They are particularly pleased by the way PBs and IBs are supporting young people over the transition period. In April 2011 they joined their children and adult services together with the aim of smoothing transition further. Between 12-15 young people a year move from children to adult services, in the last year, 10 families have chosen to have PBs or IBs which have remained at the same level, or increased following transition, and has removed the worry that many families experience when a young person moves to adult services.

They use their own personalised assessment process, their RAS which they developed with input from In Control. In Control also supported them to develop their support planning and a personalised approach is now used by all social workers and with all families. They are committed to co-production and have an active parents group Listen for Change and a children and young people’s group who play a crucial role in quality assuring and evaluating services.

Families are mainly using funding to enable them to access universal leisure and social activities. Some are beginning to pool their funding to facilitate them doing so together.

Contact: Stan Taylorson stan.taylorson@southtyneside.gov.uk

62 http://www.in-control.org.uk/related-pages/support/support-for-organisations/ras/how-ras5-works.aspx

63 See 53 64 http://www.westsussex.gov.uk/living/social_care/adults/getting_social_care_support/paying_for_your_su

pport/how_we_decide_how_much.aspx 

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Essex County Council has developed a RAS to cover social care and health and are utilising existing education funding bands for their tri-partite individual budgets.

For further information contact Georgina Parkin, Personalisation for Disabled Children - Individual Budgets georgina.parkin@essex.gov.uk

Changing culture and behaviours

Fundamental changes in attitudes and behaviour lie behind personalisation and personal budgets as described above. In effect people who have been used to having power within a tightly defined system will need to relate differently to service users and their families sharing power and information with them. They will need to rediscover or learn to trust their professional judgement more and rely less on rules including assessment criteria and thresholds for different services. This sort of cultural change is well described by In Control and also in a related field in the Munro report. See: Munro final report

Personalisation requires for example that rather than panels of professionals determining the services families receive, parents/carers and young people together with professionals make those decisions. See for example Cambridgeshire County Council’s agreement for funding decisions and delegation, Appendix 4.

Such change can be accelerated by:

Good training and development programmes and on the job training – see

Commissioning Support Training Materials65

Learning from other places where cultures and behaviours are different

Different approaches to regular supervision and other 1:1 meetings with line managers

Publishing good feedback from service users widely

Rewards and recognition for people who are doing well in the new system

Challenging unacceptable behaviours, encouraging peer challenge and sometimes in extreme situations whistle blowing and use of disciplinary procedures

Different approaches to annual appraisal, setting personal objectives/training plans

New job descriptions and person specifications sometimes followed by recruitment of different sorts of people when vacancies arise

Appointing new leaders and managers with a clear brief to lead change

Moving people into new locations and/or new organisations under new leadership

Changing attitudes to risk and risk sharing

There will also be a need to develop financial skills and secure input into the RAS. Finance staff as well as frontline practitioners and others will need to be involved.

65 http://www.commissioningsupport.org.uk/events__training/csp_events__training.html

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My name is Debi and I am originally from Manchester. I have an amazing son called Ryan who has a wicked sense of humour and the most contagious laugh you have ever heard.

Ryan has various complex needs and has been receiving direct payments for his care for around a year. Previously we were receiving respite - or 'stresspite' as we called it - and as a family we felt it wasn't working and making us feel very isolated. As a working mum I needed more flexibility and choice in how we were supported.

The introduction of direct payments for Ryan's care gave us the choice and control we needed. We can ensure Ryan is involved with mainstream life and we have been able to build and expand our community network.

We now have two personal assistants for Ryan, with whom he has built strong relationships and we are able to do much more. Ryan is getting grounded in his own community and gaining real life experiences for his journey throughout life. Ryan is a valued member of society who can give something back and best of all we are ensuring he is part of 'mainstream life'.

I remember recently Mo's (one of Ryan's personal assistants) mum saying since she had Ryan in her life she has built more relationships with neighbours and people on her street than in the last twenty years because with Ryans outgoing lively nature nobody can walk past him in the garden without talking to him and enjoying him! Ryan gives so much back.

Recently Ryan's school asked for our consent for him to take part 'casting' day for the BBC who were looking for children who were confident in front of a camera and talked spontaneously. This was Ryan's moment and being a very chatty boy he actually got a part in a new programme on CBeebies called Mr Blooms Garden.

We have held such a positive attitude and high expectations for Ryan from a young age and we are so proud of him being a person in his own right. Anybody who meets him would say what a 'character' he is and now he actually gets paid to perform!

http://www.in-control.org.uk/support/support-for-individuals,-family-members-

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In 2008, Essex County Council commissioned the Essex Coalition of Disabled People (ECDP), in partnership with OPM, to follow a group of service users over three years, tracking their experiences of setting up and using cash payments for their own care and support.

This study provides a unique opportunity to understand the experiences of people living with a personal budget and how these experiences change over time. The study also involves engagement with frontline practitioners and service providers to assess the effectiveness of systems, processes and the local market in delivering positive care outcomes.

OPM have published a series of briefing papers which distill the key findings from the longitudinal study.

http://www.opm.co.uk/briefings-understanding-personal-budgets-for-adult-social-care/

Developing the market of service provision

In many areas there are only a few service providers, in some those provided by local authorities and the NHS still have a monopoly. Commissioners need to try to change these but may also wish to enable and encourage the emergence of new service providers able to demonstrate their commitment to personalisation from the start.

The example from Kent overleaf shows how the local authority has supported the development of parent led childcare provision for disabled children across the county.

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Kent County Council (KCC) has reconfigured family support services over the past five years for disabled children and their families, so they are provided from five multi agency resource centres across the county. Each resource centre area has an overnight short breaks unit which is retained within the ownership of KCC as well as a short breaks/single point of access for information delivered through five parent driven charities.

It has been part of KCC’s disabled children’s strategic agenda over several years to develop four additional parent driven charities in the same vein as the parents consortium to cover the county. The parents’ consortium operates in the north west of Kent and have been successfully running for fifteen years. These new charities have been set up as charitable companies limited by guarantee and KCC’s disabled children’s service has demonstrated its commitment to their sustainability by funding their core costs i.e. a manager and part time administrative assistant during the early stages of their development. Each charity, including the parent’s consortium, employs a part time DCATCH worker (disabled children access to child care). They are currently researching need in relation to childcare as well as piloting projects. .

The four new charities now have growing memberships. They facilitate developing consortia of disabled children’s service providers across Kent to assist commissioners in the identification of gaps in service. This has enabled prioritisation and better targeted procurement of short breaks services. The charities’ network of specialist and mainstream providers across the county leads to greater enablement of all disabled children and their families to access short breaks regardless of the needs of the disabled child. They also facilitate family days to encourage engagement. They are particularly interested in early diagnosis support to families and are developing mechanisms to progress equity of access to short break services as well as to engage in the Common Assessment Framework processes across the county.

KCC have built on national evidence which demonstrates that the strongest charitable boards are made up of a blend of stakeholders, experts and people who represent the public interest. However in order for these charities to be parent led, parent trustees had to form the majority. Parent trustees required considerable support in their developing roles particularly in resolving any conflict of interest issues. Parent’s had to learn to be objective and their charity required to encompass the needs of all disabled children. KCC therefore employed consultants with infrastructure expertise to work directly with parents over a two year period. Parent trustees were offered training in parent participation; voluntary sector governance, fundraising, business planning, employment law and role of a chairperson. Consultants were required to report on at least a monthly basis to a KCC lead officer in a county resource network meeting. This enabled shared learning of expertise, economies of scale as well as the monitoring of progress. This network fed into the east and west Kent disabled children’s development partnerships which in turn was accountable to the Disabled Children’s County Strategic Partnership (multi agency) and the then Kent’s children’s trust board.

Manager’s and parent trustee chairs of each charity continue to be accountable through that process and through regular partnership meetings. They have also requested bi-annual honorary officer’s meetings where they have a direct interface with commissioners

For further information please contact: gill.essex@kent.gov.uk 01233 652125

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In some areas for example short breaks for disabled children there is evidence that the market has been developed. Action for Children research into short break services provided evidence that local authorities continued to provide overnight short breaks, both residential and foster care in house – it was community based short breaks that were more likely to be commissioned out. Local authorities suggested this was because their commissioning decisions were driven by a combination of a desire for high quality services and a competitive price. Reasons for commissioning externally were: cost, added

value; better outcomes and specialist expertise.66

See also cost comparison of short break services for disabled children and their

families.67

Gloucestershire County Council has developed inclusion contracts, one in the arts and leisure sector and one in the sports sector, through which they commission an umbrellaorganisation to develop inclusion in their sector. These umbrella organisations support a wide range of providers to expand provision and access for disabled children throutraining, networking, information and specialist support. They also promote parents’ knowledge and confidence in inclusive activities in meeting the needs of their children. A crucial element of this work is

gh

the facilitation of co-production of activities by families,

es eing incorporated into the

ontact: Alison Cathles alison.cathles@gloucestershire.gov.uk

providers and commissioners.

These contracts also enable providers to secure additional funding to run inclusive activities above and beyond those resourced by the Council. This approach is resulting in some very creative activities, and a recognition that leisure and sport activities can achieve a wide range of outcomes for disabled children and young people above and beyond short breaks, including independence skills, confidence in being in the wider community, improved ability to be in groups and social situations, interests and abilitithat can potentially lead to work experience. This is now bemployment strategy for people with learning disabilities.

C

66 Evaluation of the Impact of Action for Children Short break Services on Outcomes for Children - Final Report, Report to Action for Children June 2011 - Samantha McDermid, Jean Soper, Clare Lushey, Doug Lawson and Lisa Holmes 67 Cost comparisons of short break services for disabled children and their families, May 2012, Samatha McDermid and Lisa Holmes, Centre for Child and Family Research, Loughborough University http://www.lboro.ac.uk/research/ccfr/Research/Exploring%20costs%20and%20outcomes/DCSF-RR224.pdf

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Workforce planning and development

The Children’s Workforce Development Council (CWDC) developed a tool – the one children’s workforce tool to help local areas to establish the progress they have made in developing a workforce and culture that is reformed and integrated and making the best

contribution. 68

CSP has a training module to support discussion and usage of the tool. See CSP

See also Bolton’s staff training and workforce development toolkit developed as part of their work on Aiming High for disabled children. See: workforce tool

The Children Improvement Board (CIB) is a partnership between the Local Government Association (LGA), the Association of Directors of Children’s Services (ADCS) and the Society of Local Authority Chief Executives (SOLACE) supported by funding from the DfE.

CIB supports local government’s overall approach to sector led improvement.69

See also practical tools developed as part of the Integrated Local Area Workforce Strategies (InLAWS) project to take a rounded view of commissioning and workforce

development.70

Information to support individual choice

For personalisation to work, families need clear, concise information about services and service providers. Information needs to be accessible and give information about outcomes.

Aiming High resulted in some exciting initiatives in support of this ambition. For example, as mentioned earlier, Suffolk County Council has established activities unlimited, a new website and service for families who have children with additional needs to find out about short breaks. Any child or young person who has additional needs, aged 0-25 can enrol as can any professional or provider. See www.activities-unlimited.co.uk.

Cambridgeshire County Council provides information to parents/carers about the costs of

both in-house and externally commissioned services.71

In addition, children and young people and their carers may need support to develop their ability to make choices.

68 See www.childrenengland.org.uk 69 www.local.gov.uk 70 http://www.skillsforcare.org.uk/workforce_strategy/InLAWS/Workforce_Commissioning_InLAWS.aspx 71 http://www.cambridgeshire.gov.uk/childrenandfamilies/specialneedsdisabilities/shortbreaks

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Rowden School in Herefordshire is part of the SENAD group. The school caters for young people aged 11–19 years with severe learning difficulties, complex needs and/or challenging behaviour. Within the West Midland Learning Campus services are also provided for transition, community support and adult residential care.

The personalisation agenda is an area of work that continues to be developed for young people and adults who are non-verbal but have wishes, feelings and emotions like anyone else. The key stepping stone to personalisation begins with effective communication, how can choice for the young person or adult be effective when based on someone else’s interpretation?

The School is introducing touch screen technology into the dining area so that young people can choose which meal they want and the order is then individually prepared in the kitchen. Previously if a young person appeared to look at a meal picture the member of staff could interpret this as meaning that the young person wanted this, when in actual fact the opposite could have been true and individual choice and control would not have been enabled.

To further bridge communication barriers a tap talk communication tool framework (visual and audio) utilising an android tablet is also being developed, with drop in symbols and pictures to facilitate choices, feelings and wishes. Information from this system will be backed up on a server and key information produced to assist personal planning and personalisation. Each young person will have their own communication tablet for use in School, in their bungalow and at home and it will also allow young people to share information and Skype with their parent(s) and carers.

SENAD welcomes discussion with other colleagues on developing communication tools. Contact Kim Aimes, project lead and registered manager at Rowden School KimA@rowdenhouse.com

Families may need support to develop appropriate outcome focused plans which deliver the outcomes and meets the needs identified in the assessment process - this is likely to be even more so with the advent of a single plan.

Families may also need support to manage the plan, the budget and often support workers. This support may come from their key worker/lead professional, a social worker, a voluntary organisation or another family.

There are many different approaches to offering this 'support to plan'. All the models involve a commitment to fund. Examples include:

The commissioning of a support planning hub in Newcastle, where 'Skills for People' provide a buildings based information and planning hub for any and all those involved in developing support plans for disabled children, young people and families.

Re-commissioning a local community based children's centre run by Barnardo's to include the offer of support planning and plan management support in Halton.

A number of parent and family forums taking up this role in Calderdale and Bury.

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Commissioning the VCS for example KIDS to support families to develop and use personal budgets in Hull.

Using a number of different voluntary organisations who offer ‘account managements services’ to families in South Tyneside.

Budget holding lead professionals (BHLP) where the lead professional manages the personal budget on behalf of the family. See section on BHLP above.

C-Change has supported people to manage the money available for their support using Individual Service Funds since the organisation’s inception in 2001. An Individual Service Fund enables people with additional support needs to experience the benefits of a direct payment without the added work and responsibility associated with being a direct employer.

There are many reasons why families with children with additional support needs may choose not to manage an individual budget directly, including the day to pressures of family life, difficulties with household finances and the perceived complexities of being an employer.

Managing an individual budget using an Individual Service Fund enables families to retain control over their child’s budget, what it is spent on, how and when direct support is received and who works directly with them.

Families are assisted to design their support arrangement, to recruit the right people and are given quarterly financial statements in order to help them manage their budget. C-Change provides finance, personnel, training and planning advice and support at an agreed level for a fixed rate, the cost of which is determined on an annual basis.

Example

Heather and her family - Heather is in her mid teens. Attending her mainstream school was very difficult for her and the specialist autism residential school she tried did not work out. The local education and social work departments agreed to fund her support using an Individual Service Fund managed by C-Change. Heather and her family designed the support that she would receive within the family home and in the local community. It was important for her parents that Heather’s direct support enabled them to keep working and was sympathetic to the needs of her siblings and their family life. Social work, health and education worked closely together in support of Heather and her family. The education department, including her former teachers, worked with C-Change to develop a plan to ensure that Heather could continue her education in a way that made sense for her. The team members working directly with Heather were selected by her and her family. Heathers support continues to evolve as her needs change.

Names have been changed to protect confidentiality.

For further information contact: Sam Smith, Director, C-Change, 0141 427 2946 http://www.c-change.org.uk/

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Different ways of commissioning

The degree to which devolved budgets either through BHLP or the use of PBs can help transform services is limited by how far providers develop personalised services and support that children and families want to buy. Some providers have always taken the lead in personalising services. Others are either not aware of the need to do so or need help in transforming their current range and types of services including how they are costed and accessed.

Confronted by this challenge in adult social care commissioners have developed a three pronged approach to market management72 (see figure 9).

Personalised services

Personal budgets

Framework contracts

Personal budget holders using ISFs to purchase services from personalised service providers

Figure 9: Contracting for personalised outcomes

Personal budgets – it is essential to signal to the provider market that PBs are here to stay and that they will develop to such a volume that there is an overwhelming business case for personalising services. Experience from the adult world and the use of individual service funds whereby an individual decides on their support plan and then arranges with a provider to source and manage the support on their behalf is that this has resulted in a much faster take up of budgets than ever before.

The North East Procurement Organisation (NEPO) are working with interested local authorities to develop market positioning statements. 73

Service personalisation – direct support is given to providers to help them understand how devolved budgets and self directed support works and the types of

72 Contracting for personalised outcomes, DH, 2009

73 http://www.northeastiep.gov.uk/NEPO.htm

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personalised services that people are wanting. Help can also be provided with staff training and development and the change over in financial systems to handle the costing and billing of services on a per person basis.

See for example how Lancashire County Council worked with Castle Supported Living, a local provider In Control and Lancashire CC

See also Think Local Act Personal (TLAP) shaping the market for personalisation

diagnostic and action planning tool,74 Commissioning blueprint75 and Progress for providers, a diagnostic tool which is designed to support providers to evaluate their progress with delivering personalised services and to acquire a 360-degree

perspective on market shaping across an area.76

Procurement techniques

Commissioning for personalisation and PBs requires changes to be made in the way in which services are packaged, planned and procured.

Commissioners will be looking for services that are more flexible than before e.g. clinics that provide specialist advice and therapy after school hours or on Saturday mornings, ‘short breaks’ at weekends and after school rather than just in the school holidays, support workers able to accompany disabled young disabled people to socialise at weekends77 e.g. going clubbing or to watch a football match. Services which help young disabled people to get used to using public transport rather than specialised taxi services where possible.

There may also be a need for more service providers who cater for young people through the transition to adult services. (PBs can make transition much smoother by helping to avoid the traditional ‘all change’ which is so difficult for many young disabled people).

Traditionally, services for disabled children have been secured using a contractual payment for a fixed set of outputs via block contracts. Block contracting was regarded as an efficient way of delivering agreed services to children and families using economies of scale but has, in many cases, become a barrier to personalising services. Spot purchasing services i.e. individual transactional payments on completion has also long been used to procure provisions in children’s services. Spot purchasing can, however, result in a higher unit cost although it may work well when volumes or budgets are uncertain, as it avoids the risk of contract failure when clawing back revenues is not desirable or straightforward.

74 http://www.thinklocalactpersonal.org.uk/_library/Resources/Personalisation/TLAP/Shaping_the_market_12.4.11.pdf 75 http://www.thinklocalactpersonal.org.uk/Browse/commissioning/blueprint/

76 http://www.thinklocalactpersonal.org.uk/Browse/mir/aboutMIR/ 77 See for example http://www.cool2care.co.uk/

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Gloucestershire County Council has reduced the number of block contracts they have, and developed contracts that provide an element of block contracting to support business viability, with the remainder of the income coming from individual commissioning on top of the base amount.

They have also now successfully individually commissioned a children’s home based residential short break programme for one young person with very complex needs.

Contact: Alison Cathles alison.cathles@gloucestershire.gov.uk

There are many examples of procurement and commissioning colleagues working together to explore procurement techniques which improve efficiency, ensure user involvement and improve outcomes.

The Children’s Improvement Board supports the National Local Government Collaborative Commissioning Group. The Group is working on the social services category of local

government spend.78

Block contracts – pros and cons

Enable commissioners to potentially get better value for money via block buying places and negotiating volume discounts

Enable commissioners to work with young people and parents/carers to determine need and to purchase services on their behalf

Can bring new providers in by guaranteeing income 79

Children, young people and parents can draw down provision

Funding may be able to be clawed back if the provision is underused

Providers can be incentivised to personalise their services and actively promote them to children and young people and families particularly ‘harder to reach’ families

May result in a fixed offer with lack of flexibility to respond to families needs

78 https://knowledgehub.local.gov.uk/home 79 See KIDs short breaks procurement guide: advice for efficient and effective block contracting, May 2009 http://www.kids.org.uk/files/103937/FileName/ShortBreaksGuidelowres.pdf

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Action for Children (AfC) supports over 15,000 disabled children and young people throughout the UK. They deliver over 70 short break services and strive to achieve inclusion in their universal family support, youth and children’s placement services. Their short break services are primarily block contract funded but they are beginning to see the emergence of alternative ways of commissioning such as short term grants and framework agreements. To date they have some experience of direct purchasing from young people and their families, particularly where young people with significant support needs have transitioned to adult social care and seek to continue their services, particularly those which enable bespoke access to sport, leisure and cultural activities.

In preparation for the future and in anticipation of increasing numbers of disabled young people and their families seeking to secure support through a personal budget they have started on their journey of organisational and cultural change. They commissioned independent research which demonstrated that staff already worked in an effective personalised way and that AfC has a positive child-centred approach. Frontline services operate within a personalised culture for example offering choice where possible and social inclusion. Their research and market analysis helped senior managers to consider risks and opportunities, and begin to strategically prepare for the new landscape. See: http://www.actionforchildren.org.uk/policy-research/research

They are conscious that this is a vital stage as changes will impact on all aspects of their day to day operations, including back office functions where policies and procedures are being revised. Trainers have been trained to deliver an organisation wide programme to ensure all staff have a good understanding of the agenda and to help them consider what this means for their role. They have developed a frequently asked questions section to assist services with developments.

To develop their offer it was first necessary to have an understanding of their unit costs, including the challenge of costing short breaks that are part of a hub model. AFC are responding on a needs-led basis to families who have approached them to purchase support with a direct payment which is enabling them to take a step change approach to testing out key areas, for example:

Providing young people and families with a quote for the type of support that they have in their plan

Piloting how they can efficiently manage the financial transactions

Investigating how they can be increasingly flexible and responsive to meet young people’s aspirations and testing new services and approaches

Contact: Clare Gent, Strategic Development Manager, Disability Clare.Gent@actionforchildren.org.uk

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Darlington Borough Council has been using outcome based accountability as a model to develop service specifications. The model based on the work of Mark Friedman looks to identify the outcomes required for a group of people, for example adults with a mental health problem and then looks to identify those services or solutions that need to be commissioned to meet those outcomes rather than assume that existing or traditional models are needed.

The model also focuses on the measuring of outcomes as a means of quantifying value for money. These outcomes and their measurement form the basis of service level agreements. In Darlington preventative support for adults with a mental health problem had been commissioned through a traditional block contract with a specialist mental health provider. Following an outcome based accountability session the proposal is to now commission a range of low level preventative measures by supporting the local mainstream and universal services to develop a more inclusive model that can support people with a mental health problem. For example a small grant to a local karate club, the condition of which is that they have to undergo mental health first aid training, link with social prescribing and show some evidence of including the whole community.

Contact: Mark Humble, Strategic Commissioning Manager Mark.Humble@darlington.gov.uk

Framework contracts – pros and cons

These fix the price and quality of services but not the quantity to be provided.

Can be used to require providers to meet certain quality requirements such as supply personalised services

Can enable the individual with a personal budget to choose the services most likely to meet their desired outcomes

Can give providers included on a framework an external stamp of approval

Can support closer strategic working between commissioners and providers enabling providers the opportunity to help shape the market

Can ensure providers are accountable back to the local authority for the services they provide

Do not guarantee the volume of services that might be purchased as budget holders are free to buy from contractors on the framework or from others outside of the framework.

Calderdale Council uses a framework to source high quality and value for money short breaks.80 The National Contracts Steering Group has developed national framework contracts for use by commissioners and providers covering day and residential independent and non-maintained special schools, residential homes and independent fostering.81

80 See http://www.calderdale.gov.uk/socialcare/family/disabledchildren/short-breaks/index.html 81 https://knowledgehub.local.gov.uk/group/nationalcontractssteeringgroup

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Dynamic purchasing system (DPS) – pros and cons

This is a completely electronic process for making purchases which is limited in time and open throughout its validity to any provider which satisfies the selection criteria and has submitted an indicative tender that complies with the specification. This is a relatively new technique which is being used by some children’s services particularly to procure services for children in care.

Research suggests that it can generate efficiencies in the system because it provides reduced timescales for procurement made within it

It is relatively quick and simple for providers as it is entirely electronic

It allows more providers to be added during the lifetime of the system

It allows providers to improve their indicative tenders

There is no need for providers to be asked for the same information repeatedly

West Sussex County Council has actively involved parents/carers in developing a DPS to commission:

day and residential placements in special schools (38 - 52 weeks)

placements in children's homes

residential short break placements

specialist (for CWD) foster care placements

See appendix 5 for more detail.

Contact: Amanda Brewis, Senior Contracts Officer, Amanda.Brewis@westsussex.gov.uk

DPS is being used in Coventry to procure domiciliary care. 82

Purchasing by individual families – pros and cons

Families can purchase the services they want from their provider of choice

Can mean greater flexibility and choice

Can means families are able to negotiate directly with providers and that providers are able to respond better to the needs of the child

82 See: http://www.matrix-scm.com/social-care-health-care.php

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Can mean better access to universal services

Can open up life opportunities

Can sometimes secure better financial deals than a council

Can pool budgets with other families to achieve better value for money – In Control knows of examples of families pooling budgets for example to co-fund after school provision, swimming sessions or days out

May result in a lack of capacity to search out new providers/develop the market

Increasingly, local authorities and providers are exploring the concept of ‘shared risk’ in order to support providers to innovate and new providers to enter the market.

In Cambridgeshire, Aiming High funding helped change the conversation with families and with providers. The Council has successfully piloted personal budgets and expanded direct payments from 75 to 370 children and young people. Self directed support for all disabled children supported through short breaks and social care is in the process of being rolled out. The result has been a number of exciting organic changes.

Although economically challenged the Council has used these new opportunities to encourage services they know deliver most effectively to grow. For example with one provider the Council guarantees a level of funding per placement and a minimum number of referrals per quarter. Any additional referrals are then spot purchased – the more referrals the provider receives the less the Council pays per placement.

Cambridgeshire is committed to using framework contracts wherever possible to provide maximum flexibility and to support the move to personal budgets. In a second example, however, the Council has awarded a long term block contract (5 years) to a provider where a framework approach would not have been appropriate. The aim of the contract is to support disabled children to access mainstream services and those services become fit for purpose and self-reliant thereby decreasing demand on commissioned services over the years. The Council is carrying out a longitudinal study of this particular initiative. This includes identifying the number of disabled children who continue to access a mainstream activity once the support provider is no longer working with them.

With a third provider, they are working with them to develop a way of monitoring usage quarterly so that i) children and young people receive all they are entitled to ii) families don’t hold back on usage and then want all the services at the end of the year. The work

Southend Borough Council has funded the charity Friends and Places to run a pilot project to support 15 young people who are moving on to college. The funding (£750 per person) is to extend their use of universal services, their friendship networks and opportunities to pool budgets in order to obtain increased value.

See: http://www.openfamilyservices.org.uk/ofs/directory/Southend-on-Sea_Borough_Council/21469

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being undertaken highlights some of the tensions between a pure short break provider seeking to offer a very flexible service and the Council who will have a continuum of needs to be met including where some children have needs that require a very prescriptive service.

The Council has agreed with families they will give providers 3 months notice if they want to move their personal budget out of an activity so that providers know they have sufficient funding to deliver a service and are, therefore, able to cover the financial risk involved with renting premises or employing staff. This agreement alone has changed the relationship between families and providers.

The Council and PCT continue to jointly block commission one overnight short breaks service only. (They have closed one other short break service as a result of reduced demand).

The remainder of their community services are spot purchased from an open approved list of domiciliary care providers. Care is procured for each child individually on the basis of need with providers given one week to respond to referrals. Providers are rated according to the location of the worker, when they are available and the worker’s ability to meet the child and families needs. The intent is that this system will evolve to enable families to choose which provider they use. The Council is actively working with providers to support them to better describe their services to parents/carers and young people themselves.

Contact: Richard Holland Richard.Holland@cambridgeshire.gov.uk

Payment by results – pros and cons

This is a relatively new concept in children’s services. In the drive towards value for money in public services, the concept of “pay-by-results” is receiving greater attention and focus. DfE has recently announced an extension of their trial of payment by results for children’s centres. Together with the first wave announced in July 2011, a further 27 local authorities will be testing rewards for reaching the most vulnerable families, improving family health and wellbeing and raising attainment of children at age five. See Payment by results

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Pay-by results & managing risk - a view from Cool2care

Is it possible to deploy a greater level of pay-by-results across the disabled children’s sector? Can it be used for personalised services when outputs and outcomes may vary widely, and may not be easy to capture in terms of a block contract? Can pay-by-results save money for local authorities?

The answer lies in understanding the level of risk at the heart of the contractual agreement. Pay-by-results can deliver better value for money, by sharing risk between local authority and provider. It is important then to understand how to share risk appropriately, and not view it as simply delegating risk.

For example, if a local authority commissions a historically stable service e.g. domiciliary care, then the risk to the provider is low, and pay-by-results may be appropriate. However, if a local authority commissions a new, innovative service, the risk of underperformance is high. Therefore the risk the provider will not recover costs is also high. This may not be an appropriate way to develop a new service, when some degree of trial and error is both required and inevitable in order to learn how to deliver such an innovative service in future. The commissioner may regard a new service as risky, and hence is tempted to load risk onto the provider. This presents a high degree of risk to the service overall, and failure to deliver is not desirable for any party.

Commissioners also need to think through cashflow for the provider – pay by results implies paying after the event rather than before, which can place the provider in difficulty in managing cashflow.

There are new solutions being trialled that address some of these issues. Guaranteeing a regular payment amount to the provider can offset risk to the provider. Payment of full costs followed by a variable revenue claw-back is also possible. Both of these methods in effect blend the concepts of block contract and pay-by-results.

The Social Impact Bond is a new innovation in the field of Social Investment that involves a third party to supply the up-front contract payment, and the local authority pays the third party based on results achieved. Risks are thus more evenly shared between all parties.

In general when sharing risk, it is important to remember that the disabled children’s sector is one of the weaker sectors. It is characterised by a large number of local charities, high in motivation but low in reserves and business acumen. One cannot treat a local disabled children’s charity in the same way as a major national for-profit public services company. Sharing risk is best done slowly and gradually, and mindful of the characteristics of the provider involved. Shaking up the market may appeal to more innovative commissioners, but as everyone now knows, markets can fail. Ultimately commissioners must shape markets, not destroy them.

Cool to Care phil.conway@cool2care.net

DfE’s commercial group has published a range of documents to help commissioners understand, use and apply commercial and procurement skills. See: DfE procurement skills

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Joint and collaborative commissioning

If commissioning is to deliver improved outcomes via personalisation it must be able to focus on the lives of children, their families and carers and their local communities. This requires joint working and therefore commissioning across:

Children’s services – notably between: individual schools and schools forums as commissioners; and children’s services departments. This is being supported through integrated service arrangements, for example, based on schools clusters and Sure Start areas. Some school forums used their pooled resources to continue the funding of BHLP after the DCSF funded pilot phase was concluded.

Cross sector – with health, employment, housing, leisure, police and other organisations. At a macro level this can involve radically rethinking how services work together and are financed, as in the ‘total place’ pilots83. At an individual level the expansion of personal budgets to cover targeted services outside of children’s services.

Over a period of 5 years Talbot Special School in Sheffield supported approximately 50 of their school leavers with severe learning difficulties to use adult social care, health and LSC funding so they could move into independent accommodation or remain in their parental home in Sheffield after they left school.

As a result all the school leavers remained in the Sheffield area. One young man received funding from the Independent Living Foundation, LSC, health and adult social care to create an independent living package which enabled him to live independently in the community in his own accommodation.

Another young man received funding from health and education to enable him to remain living at home. Young people leaving Talbot School are now automatically considered for independent living with joint funding from adult social care and health.

Contact: Pippa Murray pippa@bknitiatives.com

Cross age groups – ensuring effective transitions for example using a common approach between children’s and adults’ services to allocating resources to individual budgets in line with need; investing in the health and well being of children as a means of improving health and well being in adulthood; and meeting the needs of children by focusing on the needs of both children and adults through developments such as ‘think family’84. Many of the SEN pathfinders are focusing on transition services, some in

collaboration with their neighbouring authorities85.

83 http://www.localleadership.gov.uk/totalplace/about/ 84 Think Family Toolkit: improving support for families at risk – strategic overview, DCSF 2009 85 www.sendpathfinder.co.uk/foodforthought

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Collaboration between a number of local authorities - in some places working with other local authorities to commission a service or services may be the right way forward. For example in Greater Manchester collaboration between ten local authorities has resulted in a better offer of further education for disabled young people as is described in the box below.

Since the demise of the Learning and Skills Council in March 2010, and the transfer of responsibility for the planning and commissioning of education and training for 16-25 year old learners with learning difficulties and disabilities (LLDD) to local authorities, the ten local authorities in Greater Manchester have worked together to commission places from independent specialist colleges and have put in place budget management arrangements to fund places with the Young People’s Learning Agency as the budget holder. Greater Manchester was given Combined Authority Status from April 2011 to deliver key functions including aspects of young people’s post 16 learning, and up to 25 year olds for LLDD.

This will ensure best use of resources and value for money through economies of scale and better commissioning outcomes. However there are implications when the LLDD budgets currently held by the YPLA (from April 2012 the Education Funding Agency) are transferred to local authorities from 2013/14 onwards (awaiting confirmation of policy). This is likely to be held at a Greater Manchester level which provides opportunities and challenges for local authorities to work together. Greater Manchester is in a strong position as this is how they have operated for the last 12 months in commissioning places at specialist colleges for those learners with LLDD up to the age of 25.

The Greater Manchester lead officers for LLDD education and training provision for 16-25 year olds in local authorities meet every six weeks to discuss a range of issues from the policy drivers in the sector to progression into positive destinations for young people on leaving provision. Whilst there is a focus on post 19 interventions, the group are all working towards an integrated agenda within local authorities with SEN teams, Connexions and transition for the young person from school to college and/or from children’s to adult care services.

The group works together on a Greater Manchester response to national developments, such as the learning for living and work framework and the SEN pathfinders, as well as the development of local practice and joint approaches, such as with contract management issues and the negotiation of equipment costs with local and residential colleges. Collectively there has been sharing of approaches to negotiating third party contributions from health and social care towards the placement of a young person at a day or residential placement in an educational setting, where the young person has care and health support needs in addition to educational goals and a joint funding package is required. Five local authorities within Greater Manchester have SEN pathfinder status which is conditional on a consortium approach to sharing the learning and outcomes across the remaining authorities. Each pathfinder is looking at personalisation across different phases. The personalisation of the 19 -25 phase of education and learning is particularly relevant to this group given its focus and current budget management remit.

Contact: Ruth Wheatley, Head of 14-19 Commissioning and LLDD R.Wheatley@bury.gov.uk

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Key points:

1. Whole system change – ensure that there is sufficient leadership capacity to ensure change happens

2. Use SQW’s Common Delivery Model to ensure all the necessary elements for change are in place

3. Develop a timetabled and costed workforce strategy – to include awareness raising sessions across all relevant service sectors and parents/carers

4. Commissioners and procurement officers should work with parents and providers to explore how different procurement techniques might be used to improve efficiency, ensure user involvement and improve outcomes.

5. Develop the provider market by building on techniques used in other areas; talk particularly to providers with a track record of enabling access to universal services

6. Involve potential providers and budget holders in on-going activity so that providers grow their understanding about what families want and how personal budgets will impact on their offer.

7. Supply providers with regular information about:

a. Trends in volume and type of services demanded

b. Gaps in provision

c. How providers market and budget holders learn about services

8. Work with providers to support them to make the transition from block contracts to a retail model

9. Work with commissioners in neighbouring authorities to look at opportunities to stimulate the market

10. Maximise opportunities for budget holders to secure value for money by supporting effective networking and communications

11. Provide training in and provision of peer to peer support for both children and young people and their families.

12. Facilitate networking opportunities for families so that families can hear how personal budgets are being used to extend personalisation

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4. Review – stage four of the commissioning process Commissioners need good quality performance information and analysis to help them judge the efficiency and effectiveness of services and to justify changes to internal and external services and contracts in order to achieve an excellent standard of service delivery. They need to build in a review system that includes and respects the views of children, young people and families and places these at the core of the system.

Performance management

Where performance management indicates that services are inefficient, ineffective or unsustainable, commissioners should either support and challenge that service to improve or decommission it and find another provider to meet the identified needs.

Commissioners will want to develop systems that monitor outputs, finances and crucially, quality and experience of service (including feedback from children and families) in order to reach a view about whether outcomes are improving.

Performance management techniques influence the way providers behave – commissioners will want to ensure that providers focus clearly on outcomes and on feedback from disabled children and their families.

Commissioners can do one of five basic things when performance managing services:

1. Disinvestment or decommissioning is the process of planning and managing the elimination or reduction of service activity or investment in services in line with commissioning objectives

2. Remodelling is the process of negotiating changes to the service specification with an existing provider to ensure they align with needs

3. Renegotiation is the process of improving performance in delivering the contract

4. Maintenance is the process of ensuring continuity of service provision, price and quality

5. Commissioning new services is the process of securing services to meet new or changed needs.

CSP has developed a helpful suite of training materials about performance management

including information and training about de-commissioning. 86

86 www.commissioningsupport.org.uk

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9

Maintain

RemodelDecommission

Renegotiate or end contract

Poorquality

Good qualityQuality

Poor alignment with needs

Good alignment with needs

Nee

ds

Figure 10 What option to choose?

What can be monitored and what is monitored are often very separate; because resources invested in monitoring are usually only a very small proportion of the value of a contract in health and social care. Note that any monitoring will come with a bureaucratic overhead and therefore a cost which will reduce the funding available for core services.

Taking a proportionate approach

Relate the investment in monitoring to the risk. Levels of action based on risk e.g. named contract manager for contracts over a certain amount, major contracts, have a timetable etc. Risk could be based on:

Value of contract

Safeguarding issues

Number of service users

Other factors such as political or strategic importance or high profile

In addition, use self assessment and provider performance indicators plus random sampling to ensure honesty and accuracy. Use unannounced visits strategically, consider using local user groups to do mystery shopping. Ensure there is a balance between time used directly by contract monitoring staff and service user feedback. Ensure that all providers know what will happen if they under perform.

Always take actions that are promised, e.g. requiring return of funding if contracted outcomes are not delivered.

Publicise performance against standards to all stakeholders - make sure users and carers are informed.

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See also the National Audit Office’s staged approach to de-commissioning. See: http://www.nao.org.uk/sectors/civil_society/decommissioning_csos/a_staged_approach.aspx

Key points

1. Introduce a coherent system of review that is robust, simple, transparent, consistent, proportionate and appropriately staffed.

2. Use examples of reviews to devise appropriate, outcome focused review paperwork.

3. Ensure that reviews are designed to be sensitive enough to address risk and safeguarding issues.

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Appendices

Appendix 1 – Glossary of terms

The following is a list of key terms, in alphabetical order - it is not exhaustive.

Assessment – a formal process of collecting all necessary information about the child, family, those currently supporting the child, and their situations. An assessment will then inform the next steps in meeting the support needs of the child and their family and which service is best placed to meet the support needs of the child. (See Care Plan and Eligibility.)

Brokerage – describes the different types of support needed by a person or a family and child in making a good plan, arranging support and managing support, and a support plan in the longer term, once it has gone live.

Care Plan – an official document which states how the support needs identified in the assessment are going to be met

Commissioning – the process for deciding how to use the total resource available for families in order to improve outcomes in the most efficient, effective, equitable and sustainable way.

Common Assessment Framework (CAF) – used in most children's services across England as the initial or first assessment following the referral or self-referral of a child and their family

Direct Payments – the opportunity for families and/or people to ask for the financial equivalent of the cost of the services being offered to meet their support needs as a cash payment. This is how families take control of a personal budget and receive the 'cash' to purchase the support their child needs. In social care it is illegal to be refused a direct payment unless there are specific issues which lead to concern on behalf of the local authority which mean that they are not able to offer direct payments in an individual case.

Early Support – an approach adopted in many children's services to the early identification of support needs and bringing all adults, both parents and professionals, together to set out how those support needs will be met.

Eligibility – the assessment will collect information which will enable the service to establish which part of the children's service is best suited and funded to support the child. Eligibility is like a threshold, where a certain level of need means access to a certain team or support service.

Individual Budget – the total amount of funding allocated by state services which together add up to the support budget to meet a child and family's support needs.

Lead Professional – a role in most children's services which describes the professional, representative of a voluntary service or family representative, who takes responsibility for being the single point of contact for all those involved in supporting a child and their family.

Key Worker – similar to the role of the lead professional: the worker attached to an individual child and their family who acts as the single point of contact and support

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between services and the child and family. This role is often delivered by voluntary sector organisations.

Mainstream and/or Universal Services – a term used to describe the services, activities and opportunities the majority of the population use and take for granted as part of everyday life, such as shops, leisure centres, buses, waste disposal, road maintenance, the built environment, public toilets, parks and recreation facilities.

Outcomes – what a plan or set of actions must deliver. For a family making a plan with a personal budget, the 'outcomes' will be what the plan must deliver. An example of an outcome is 'to stay safe'. A good plan will show how the different ways a personal budget is being used will mean the child 'stays safe'.

Panel – a term used in services to describe the meeting or group of key professionals who will make a decision about the support set out in the child's care plan. The decision will either be 'yes' or 'no' and they may well ask for additional information before they can make a decision. Families are sometimes invited to attend. The term 'panel' is used a lot in services; it is part of the budget management and decision-making process.

Person-Centred Planning / Approaches / Thinking – an approach to planning which starts and centres on the individual and those closest to them. It values the individual and what they give to the world around them and it explores the individual aspirations, dreams and support needs and sets out action to support the individual in getting the life that suits them and those closest to them. This approach is most commonly used when supporting people with learning difficulties and is part of a good support plan. (See Support Plan.)

Personal Budget (Social Care) – the total amount of funding allocated by children's social services to meet the support needs of the child. Families can choose to access this as a direct payment or to ask someone to manage it on their child's behalf.

Personal Health Budget – yet to be precisely defined.

Personal SEN Budget – yet to be precisely defined.

Providers – services offering support to children, young people and their families. Most often this term describes voluntary or private services but can also be used to describe a children's in-house service.

Resource Allocation System (RAS) – a formal approach to making fair and equitable allocations of funding to the whole population of children eligible for support from a funding source.

Review – A meeting between key professionals, child and family to look at how support has been going, whether it is delivering the outcomes as set out in the support plan and whether any changes need to be made to improve the plan and support. Reviews can happen on different timescales, most often after three, six or 12 months.

Self-Directed Support – this term describes the way in which services will work, i.e. the steps from carrying out an assessment, to the child's plan being agreed, to longer-term support and review.

Services – describing all the different organisations, people and statutory organisations

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Seven Steps – an approach to self-directed support developed by In Control. This process explains the seven steps from needing help to having a review. (See Appendix 1)

Support Broker – a role taken on by someone who will support the young person/family to plan and find the support they need and, if needed, help manage the plan in the longer term. Support brokers may be funded by the children's service or from a child/young person’s personal budget.

Support Planning – a child-or family-centred approach of developing a support plan which makes good use of all the resources the family and child have and sets out how the personal budget will be used to make good use of these resources and get the support the child and family need. It will include information about how money will be managed and spent, who is responsible for delivering the plan and what happens if things are not working. The plan will also address any safeguarding concerns.

Supported Allocation Questionnaire (SAQ) or Self-Assessment Questionnaire (SAQ) – the name given to the questionnaire part of the resource allocation system; a set of questions which help allocate a fair share of funding to the child and family based on the support needs of the child. It is good practice for family members and professionals to work together in completing the questionnaire.

Team Around the Child (TAC) – an approach to supporting children with complex support requirements which focuses on the team of professionals involved working together to deliver child- and family-centred support.

Voluntary Sector – charities and other organisations outside of the public (state-funded) and private (for-profit) sectors.

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Appendix 2 - Seven Steps of Self-directed Support87

In its publication87 on its work with the Taking Control group of local authorities, In Control describes the self directed support process as:

1. Need some support

Being able to access support when it is needed, at the first time it is needed, at a time of crisis, means an open door cited in a number of easily accessible places whether this be via a GP, a health visitor, a youth worker, a teacher, support assistant, the police, a voluntary organisation or a nursery

2. Identify my resources

Getting help to identify all the resources available, the 'real wealth' available, including an allocation of an indicative budget is essential. Part of this includes using the Common Assessment Framework (CAF) or similar information gathering assessments, identifying desired and necessary outcomes of support and how this support can be accessed and delivered; it is important to always ensure that best use is being made of universal services and not simply seeing this as a quick route into specialist support services/ funding services.

3. Make my plan

Creativity, local knowledge and flexibility are key to making a good plan; there is a debate to be had about who is best placed to give support to children and families in developing a support plan. There may be cases where it is clear the social worker has responsibility but in general the more support that can be commissioned in the community, for example through an enhanced commission of a children's centre, or voluntary sector service, the better the outcomes are likely to be. This is based upon responses from families and widely supported through the roll out of individual budgets in the adult world; support from independent people and organisations with a good level of local knowledge and creative

87 Personalisation: Children, Young People and Families, Nic Crosby, In Control, 2011 http://www.in-control.org.uk/resources/children-young-people/briefing-1-personalisation-children,-young-people-and-families.aspx

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approaches to meeting support needs will generate good plans which make best use of all the wealth available including the individual budget.

If, during the building of a support plan there are questions or challenges around the amount of budget then this is a discussion to have now and not when the plan is being presented. It will be clear within the plan whether there is sufficient resource available.

4. Decide to do it

The Children's Act is clear about the responsibility to ensure that a child's identified needs are being met; the support plan outlines how those needs identified within the assessment are going to be met and how the personal budget alongside all the family's 'real wealth' is going to be used to meet those needs. A Support Plan which does not meet the needs of the child would not be agreed.

5. Organise my support

The organising, managing, employment of support and all the work that accompanies it is one area where many families are likely to be seeking help and support. How this long term support is offered is key. There is not normally the capacity within social work teams to take on this role for every family needing help but there are many examples of local voluntary organisations being commissioned to provide this role. In some areas support is provided by children’s centres, in others voluntary groups who also work with adults - such a link has the potential to set up lifelong relationships between a child, family and support service.

6. Improve my life

When the budget and plan go live there needs to be simple information and swift and supportive assistance available via a lead professional or social worker so that they are able to respond to any difficulties or crisis. This should be supported by easy to access information/guidance on subjects such as 'carry over' of funding, contingency funds, and planning and audit/accounting requirements. Where a child or young person has identified fluctuating health or support needs these can be accommodated and planned for within a plan.

7. Reflect and earn

Many formats for child and person centred reviews are being used across children's and adult services; these alongside accounts and audits should generate learning around improvements to the plan, changes in support and identify use of finance and other resources.

The process used by budget holding lead professionals in working with children with additional needs is outlined in Figure 3. It makes use of all of the integrated working processes such as common assessment, role of lead professional and team around the child as in other areas of children's services. However it does differ in that the BHLP has access to a cash budget, as of right, for a child given the following conditions have been met:

The child and parents have been fully involved in assessing their needs developing their support plan and deciding how any budget should be spent

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The support plans clearly identifies the outcomes to be achieved

The support plans indicates what the child and parent will do to achieve the identified outcomes and how the goods and services identified in the support plan are relevant to achieving those outcomes

The plan identifies both goods and services that will be procured via the use of BHLP funds and those that are already funded or have been purchased via prior contracting arrangements.

 

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Appendix 4 - Cambridgeshire County Council’s Care Package approval process

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Appendix 5 – West Sussex County Council’s Dynamic Placement System

The DPS is a framework of approved independent providers of day and residential services for disabled children and those with special educational needs. The types of services that are commissioned through the DPS are:

day and residential placements in special schools (38 - 52 weeks)

placements in children's homes

residential short break placements

specialist (for CWD) foster care placements

In order to secure a position on the DPS, providers submitted tender bids for the relevant categories and for selected disability/SEN types as per the SEN Code of Practice e.g. BESD, ASD, VI, SLD etc. The "Business" aspect of the tender could be submitted as an organisation - i.e. acting as an umbrella for all establishments named, but the "Quality" aspect of the tender bid had to be submitted by each establishment. This resulted in some organisations not being 100% successful in getting all of their establishments onto the DPS, thus demonstrating that quality is not taken as a given based on the reputation of the provider. This was particularly important to parents. To demonstrate a commitment to high quality, WSCC weighted the evaluation of bids 80% quality, 20% cost. The DPS differs from a traditional Framework in that it remains open to newcomers; Frameworks effectively close the market during their lifetime, thus potentially stifling innovation and the inclusion of new providers and/or new service developments. The DPS also meets the requirement for parental choice and any Tribunal hearing directions by being able to admit additional providers subject to the same evaluation criteria. All providers on the DPS have agreed and signed the relevant National Contract as the over-arching contract. Aims:

Providers that understood the business needs and requirements of WSCC

High quality, responsive and flexible services for children and young people

A firm basis to understand the costs associated with placements

Working with parents to make choices

A commitment to partnership working that has continuous improvement at its core

Achievements:

The DPS has the full backing and commitment of the Cabinet Members and Senior Management Group of WSCC

The approach has been endorsed by the West Sussex Parents’ Forum

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37 providers on the DPS - a total of 78 establishments

Provision of 160 service options in the following categories: BESD (day and residential), ASD (day and residential) PMLD, SLD, MLD, physical disability (day and residential), hearing impairment, acquired brain injury, specialist foster care and residential short breaks.

Each placement made is based on its own individual merit:-

Referral is made by social/case worker to Access to Resources Team (ART)

Anonymised referral is sent to all providers on the DPS (referral form developed with providers) who then respond on a standard response form

Parents, social/case workers are involved in deciding which providers to short list

Short-listed providers are sent full papers relating to the child

Provider assessments take place, offers of placement are made

Parents, social/case workers and ART decide and agree final placement choice

ART undertakes any fee negotiation and finalises IPA and documents

The ongoing monitoring and reviews of the individual placement remain the responsibility of the operational teams. Monitoring of the over-arching contract and compliance is undertaken by Contracts staff who also build a robust relationship with the providers. Outcomes:

Providers are demonstrating a real commitment to helping the Council develop the DPS - the process has provided a platform for valuable discussion

There is evidence that flexible and creative options are emerging when considering how best to meet a child’s needs

Commissioners have honest and constructive conversations with Providers about costs

There is a new spirit of openness

Enhanced feeling of trust between both parties in discussions and any ensuing negotiations.

Contact: Amanda Brewis, Senior Contracts Officer, Amanda.Brewis@westsussex.gov.uk

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Appendix 6 – additional sources of support

OPM – www.opm.co.uk

KIDS - www.kids.org.uk

In Control - www.in-control.org.uk