Ic Hartlepool Report 2006-2009

Self-Directed
Support in
Hartlepool
2006-2009
by Andrew Tyson
Self-Directed Support in Hartlepool 2006-2009
PHOTO: ANDREW TYSON
Hartlepool Borough Council | In Control Partnerships

Self-Directed Support in
Hartlepool 2006-2009
by Andrew Tyson

Publishing information
Self-Directed Support in Hartlepool 2006-2009 © In Control Partnerships
All rights reserved.

First published December 2009
No part of this book may be reproduced in any form without

permission from the publisher except for the quotation of
brief passages in reviews.
Document title published by In Control
This document is available for download

from www.in-control.org.uk
44pp.

Contents
Foreword by Nicola Bailey and Julie Stansfield �� 1
Introduction �� 2
Chapter One: Preparing for Self-Directed Support �� 4
Chapter Two: The tools for transformation �� 13
Chapter Three: Changes to the way support is provided �� 18
Chapter Four: Looking ahead �� 25
Acknowledgements and last words �� 35
Endnotes�� 36
Appendix: Who uses Self-Directed Support in Hartlepool?�� 37

PHOTO: ANDREW TYSON

Foreword
‘Personalisation’ is the Government’s term for the process to help public
services focus on the needs of citizens so that they can begin to live
good, ordinary and satisfying lives.
This is a report of Hartlepool’s progress in developing Self-Directed

Support over the last three years. It is a record of a journey still well
short of its destination, but one that we believe offers important
lessons – both for those in Hartlepool and outside. It is also a story of
a joint venture, between Hartlepool Borough Council and In Control
Partnerships to try and forge a real partnership for change, with citizens
at its centre.
The report is explicit about the need for changing systems to start
the transformation of social care, but, more importantly, the lessons
of the last three years are about serious culture change. We cannot
underestimate the significance and power of the cultural change within
Hartlepool. Cultural change has happened thanks to strategic and
operational leadership within and strong external critical friends (mostly
In Control and its associates). The work continues in new areas, including
whole-life engagement and a corporate approach. This is no longer a
simple issue for social care. It is an issue for all the citizens of Hartlepool.
We hope that the report is helpful to you wherever you live or work.
We also hope that, if you live or work in Hartlepool, the report gives an
accurate picture of some of the changes and struggles that have taken
place and truly acknowledges the hard work and dedication of everyone
involved.
Nicola Bailey, Director of Child and Adult Services, Hartlepool

Borough Council and Julie Stansfield, Managing Director,
In Control Partnerships. September 2009
Hartlepool Borough Council | In Control Partnerships 1

Introduction
This report tells the story of Self-Directed Support (SDS) in Hartlepool, a
town in northern England. Over the last three years, Hartlepool Borough
Council’s Adult Social Care Department, led by its Director, Nicola Bailey, has
transformed the way support for older and disabled people is provided so
that ordinary citizens now have genuine choice and control.
This is Hartlepool’s story, and the people of the Control) and knows it can only succeed by
town should be very proud of what has been sharing and modelling those values
achieved in their name over a short period. the importance of openness, listening to
It is not the story of a smooth transition, a others elsewhere, changing things as you go
record of changes to practices and procedures, along, and being prepared for challenges from
straightforwardly based on Government policies all quarters
and instructions that the council has simply the priority above all else of clear vision – a
implemented. Self-Directed Support doesn’t work clear commitment to the goal of empowered
in that way. citizens who are in control of their lives in
ways that they themselves see fit.
The account that follows attests to the depth,
breadth and sheer difficulty of the changes – This report attempts to do three things:
changes that have come about after a great deal
of soul-searching, planning and hard work by 1. It attempts to give a picture of what has
many people. What we are talking about here is happened in Hartlepool and provide an
transformed thinking and behaviour, deep changes account of how people’s lives have changed.
to the old, long-established ways of doing things. 2. It tries to draw out the factors which have
This transformation provides the conditions that contributed to these successes and the
determine how people who require social care and measures taken along the way to overcome
their families are now able to live their lives – the the barriers and blocks encountered.
things we glibly refer to as ‘quality of life’ or as 3. It seeks to highlight the remaining challenges
‘outcomes’ – but which actually mean something and to map the steps that we see as now
very real to most people. needed to go to the next level and embed
‘personalisation’ in its fullest sense in the
We hope that other local authorities that share communities of Hartlepool.
Hartlepool’s ambitions will learn from this report
– not because Hartlepool is ‘typical’ and therefore In saying that there is no simple map, we may be
should be imitated, or because there is a simple accused of being slightly misleading.
map here of the path to follow. Rather, we hope
others will find some lessons here because the This report in fact suggests that there is a
unique opportunities and challenges in Hartlepool sequence of measures that are necessary and are
will be echoed by unique opportunities and of central importance in each and every authority
challenges elsewhere, and intelligent, committed seeking to implement Self-Directed Support in the
people in other communities will make the values-driven manner advocated by In Control.
necessary judgements and adjustments to local
circumstances. We call this set of measures the Critical path to
transformation and this is illustrated below. This
There are a number of high-level lessons which are map was not devised until Hartlepool (and many
transferable: other authorities) were well along the road. It is
not a prescription or a recipe – it is more of a guide
the importance of real leadership – leadership or a sketch-map. This report is structured broadly
that is driven by the values implicit in Self- along the lines of this sketch-map and we offer
Directed Support (and articulated by In it as something that authorities may find useful
2 Hartlepool Borough Council | In Control Partnerships

In Control's Critical Path to Total Transformation

Partnership for the Vision
Map of Stakeholders
Leadership
Get Ready
Legitimacy
Increased Skills for All
Economic System
Support Systems
Develop the New Systems & Procedures Total

Tools Transformation
Monitoring of Outcomes & Costs
Reviewing, Learning & Sharing
Direct Payments
External Providers
Make the Care Management

Changes
Internal Providers
Micro Provision
Prevention & Reablement
Whole of life
Embed Health
Deeper
Work
Community
in drawing up detailed project plans and Project The names of the staff who contributed directly to
Initiation Documents and in reviewing progress on the report are recorded at the end, and I am very
the journey to transformation. This report is based grateful for their support and hospitality. These
on fieldwork done on three visits to Hartlepool, colleagues would be the first to say that their work
during which key staff in the Borough Council would not have borne fruit without the fantastic
were invited to put on record their observations, contribution of many staff, both front-of-house
thoughts and feelings about the process of and back-office who have embraced these new
transformation. Two of these visits were in 2006 working methods with enthusiasm and energy.
towards the beginning of the process and the This report is dedicated to the staff of Hartlepool
third was in June 2009. The quotes in this report Borough Council.
are all from these interviews, unless indicated
otherwise. Andrew Tyson, In Control

Chapter One
Preparing for Self-Directed Support
In June 2009, a senior manager in Hartlepool Adult Services Department said
‘In 2006, when Nicola arrived’ [Nicola Bailey was the new Director of Adult
Social Services]‘some people saw the need for change, but most thought that
things were going quite well and felt that there was no need to do things any
different.’
In November 2006, a workshop exercise with for social care in the Borough. This has been the
senior managers led by In Control revealed a most important single factor in those authorities
mixed picture of Hartlepool’s readiness for Self- which have become the leaders of the Self-Directed
Directed Support (SDS). In Control suggests that Support movement and it augurs well.’
there are four areas that must be addressed in
the early days: leadership; legitimacy (shared 10
Hartlepool : Readiness for, SDS
understanding and ownership); a system for 9
resource allocation; and a system for support 8

planning and brokerage for citizens, together with 7
a means to audit the system in a straightforward 6
way. In Hartlepool in 2006, the aggregated scores 5
for the multiple elements which make up these 4
four areas were 9.0, 5.5, 6.9 and 4.6 respectively –
3
where 10 represents completely ready, 5.0 is just
2
ready and 0 is completely un-ready.
1
In other words, the picture in 2006 was of a 0

Leadership Legitimacy Resource Support
Department with strong leadership, a moderate
degree of shared legitimacy or understanding
across the piece, some adequate financial systems Hartepool’s readiness for Self-Directed Support
but barely adequate support systems for citizens.
Digging a bit deeper, there were particular Hartlepool

concerns about Fair Access to Care Services criteria,
charging, support planning and especially about Hartlepool is a town of 90,000 people on the
support brokerage (helping people get what Tees Bay, twelve miles north of Middlesbrough.
is in their plan). On the other side of the coin, Its population profile shows increasing numbers
there were many good and important things in of older people and decreasing numbers of
place – not least the system to interrogate the working-age people. Eleven wards in the Borough
costs of the components of a support package, are classified as among the most deprived fifth
detailed to each individual person; and some very of areas in England. Early death rates from heart
positive work over the preceding year on Direct disease, stroke and cancer are significantly higher
Payments (DPs) and support systems for DP users. than the norm in England, and almost all of the
Most striking in 2006 was the universally positive other indicators of poor public health and of
approach of the Department’s leadership. social deprivation – including the rate of teenage
pregnancies, the rate of smoking in pregnancy
An observation recorded at the time reads: ‘It and the numbers of children living in poverty – are
is very apparent that there is whole-hearted in the highest quartile. Ethnically and culturally,
commitment from senior managers responsible Hartlepool is largely White British, with a much

lower percentage of non-White people than the at that time suggest that services to older people
average for England. were seen as the core business, with working-age
people getting support that was ‘good-enough’
Administratively, Hartlepool is a unitary authority, but which never aimed to help anyone fulfil their
one of the smallest in the country. It grew as a dreams or deeper aspirations.
port town serving the south Durham coalfield,
and developed a shipbuilding industry in the In one important respect the approach was
nineteenth century. This industry and the economy perhaps less ‘traditional’ than this summary
generally fell into decline after the Second World suggests: well before 2005/6, the Council had
War. There has been some regeneration in recent contracted out most directly provided services,
years, with the development of a marina and becoming, as one senior manager put it, ‘very
shopping centre. Politically, Hartlepool has almost nearly a commissioning organisation’. In 2006,
always been a Labour town (except for a short the Council was itself directly providing only
period in the early sixties). Peter Mandelson was an Adult Training Centre, an Adult Placement
its most celebrated MP between 1992 and 2004. Scheme, a small residential respite unit and a
Hartlepool has a directly elected Mayor, now in his centre for people with physical disabilities and
third term. sensory impairments. All other services were
commissioned from the voluntary and private
sectors. There were two small block contracts,
one for residential respite and one for day care
Social Care in Hartlepool for older people and three for domiciliary care.
before 2005/2006 Everything else was spot-purchased.
There is little doubt that this pattern of

In October 2008, the Commission for Social Care commissioning provided a favourable platform
Inspection awarded Hartlepool Borough Council for the introduction of genuinely personalised
Adult Social Care Department three stars (the supports from 2006 onwards. Despite this, there
top rating), listing twenty-nine key strengths and was still a sense in 2006 that progress was
only three key areas for development. The Council hampered by a legacy of overly-bureaucratic and
was judged to make an excellent contribution ‘top-down [processes]....there are still quite strict
to increasing people’s choice and control, with limits on who can sign off contracts... [and there
‘everyone...invited to undertake a self-assessment is]...still quite a lot of corporate control’.
and offered an Individual Budget rather than a
service’.
Looking back to the early years of the new The new Director and Direct
Millennium, things were certainly different but
it is by no means true to say that they were Payments
perceived as overly problematic or in crisis. In
fact, the departmental staff interviewed in 2006 Nicola Bailey was appointed as Director of Adult
tended to describe social care in the town as Social Care in October 2005. Her initial focus
good but somewhat traditional in its ethos and was on the Authority’s Direct Payments scheme,
management. This view seems to have been a scheme that at the time was co-ordinated by
reflected in the public perception. A postal survey Sarah Ward.
of the town’s residents in 2002 revealed that
‘Respondents are more likely to be aware of the In August 2006, Sarah Ward described a Direct
traditional services offered by Social Services such Payments scheme that was beginning to change.
as home help for the elderly and the fostering/ There were 74 people receiving a Direct Payment
adoption service than features... such as the (DP) at that point, but there had been a big
capacity to give people “direct payments” to buy increase in new interest since the Department had
their own care.’ started to re-focus, and there were then around
thirty people who were newly referred. There was
The Department in 2006 was described by the a new contract with A4E, an external provider
current Director as ‘very much an older people’s of support services, and there were other new
Department’ and several people who were around developments to push the boundaries, such as the

Worksmart initiative to help people use their DP to ‘There had been a worry that people would be
support them into employment. getting things that they weren’t entitled to’, as one
manager put it.
Underlying these changes was a new level of
energy and excitement about Direct Payments. Nicola Bailey herself talks about ‘taking up the
Nicola Bailey had set up a steering group, which DP cudgel’. Most of the proposals in the early
she chaired. days were to buy personal care, she says, and in
some cases these plans seemed to lack ambition.
Sarah Ward says ‘She chaired the DP steering group Hence she took the decision to start the monthly
herself. She made people attend! She was very clear steering groups, take the chair and sign off each
about progress, work and timescales and put a lot Direct Payment personally. She also sought
of faith in people to deliver. She was clear that we out opportunities to highlight the potential.
should learn as we went. This was a really clear One example was an approach from the Blind
message. This was a massive turning point for us.’ Welfare organisation who wanted to change
Neil Harrison, one of the other senior managers how they made use of a small grant so that it
who led the transformation process, said ‘Several was of greater direct benefit to their members.
people recognised that DPs hadn’t come off, and the Nicola’s advice was to take the grant as a series of
benefits hadn’t been seen. Nicola chairing the DP Direct Payments so that individuals could use the
steering group early on... and doing this and freeing money as they saw fit, rather than for some pre-
up some of the rest of us was really important.’ determined purpose.
As a result, care managers were enabled to see So Direct Payments were very much Nicola Bailey’s
the full potential of DPs and awareness among initial lever in Hartlepool. Disabled people on the
people needing a service had increased markedly. national scene – Lord Alf Morris and Baroness
The previously ‘bureaucratic’ sign-off process Jane Campbell, for example – had campaigned for
had been simplified and slimmed down, and Direct Payments through the 1980s and 1990s
the audit arrangements were light-touch and and eventually won the battle through a Bill set
non-intrusive. Sarah described a situation which before Parliament and the subsequent 1996 Act.
changed overnight: away from one characterised As a consequence, a number of disabled people
by caution and a ‘service culture...the shift to get across the country were able to realise their
people to think about need and outcomes has been personal dreams of independence, choice and
tremendous’. This move derived partly from a control. When Self-Directed Support came along
change of leadership priorities and procedures to from 2003, some disabled people thought that
support the new direction, but also from a shift in further changes were unnecessary because Direct
the hearts and minds of all concerned. A session Payments were already there and doing the job.
from the Moveable Feast inclusive theatre group They thought that Self-Directed Support was not
was cited as particularly important in raising only unnecessary, it was a distraction and took
awareness and opening people’s eyes to what was something away from the Independent Living
possible. movement which was fiercely proud of its success
in getting DPs on the statute book.
However, things were far from straightforward
at this early stage. One manager said ‘When There is no doubt at all that a good Direct
we started support planning, we didn’t really Payments scheme can cover much of the ground
know what outcomes were.’ This seems to be required; but neither is there any doubt that
an important point, given our analysis of the whatever the merits of the good schemes, the
fundamental building blocks needed for change. system of social care in England in the late 90s
One criticism of Direct Payments – as opposed to remained largely untouched. Most people still
Personal Budgets – is that people are sometimes received traditional services, purchased as part
encouraged to buy more of the same, and that of a block contract or spot-purchased by a care
the systems in place do not allow people to devise manager. It is interesting then to observe that
plans that link needs and outcomes and which Hartlepool’s way into Self-Directed Support and
encourage new ideas and untried solutions. what has become ‘personalisation’ was through
Certainly, there was a sense in Hartlepool prior Direct Payments, an arrangement that in the
to 2006 that some things could legitimately be Borough was far from perfect but which existed
bought with a DP, but most things could not. and was up and running. It was this arrangement

Hartlepool Direct Payments uptake third highest in England

Social Services Performance, Assessment Framework Indicators Adults
November 2008
Direct Payments take-up: the top 10 authorities
that provided the means to break the mould and Uptake of Direct Payments and ILF
move the culture in the Department and in the 
wider Council to the next level. 

It is important to note that, due to Sarah Ward’s 
operational leadership within Hartlepool’s Direct 
Payment team, there was no need (as is the case in 
other areas) to start to remove restrictive, locally 1 2 3 4 5
developed DP policies.  
Direct Payments and ILF take-up

Julie Stansfield said ‘Sarah already had the true
ethics and values. She got things right for people
by any creative means the Direct Payments team there is no evidence to indicate any increased
could use. There were no obstructive policies to demand for ILF funds in Hartlepool that result
undo. Sarah was already displaying the culture from changes intended to personalise adult
that should be at the heart of Direct Payments. social care funding.
Nicola’s support to Sarah gave her the permission
she needed to continue co-operating with real
people to get the right support.’
Four corners of the
The results of this work are evident: the number
of people taking a Direct Payment has increased Transformation Jig-Saw:
rapidly. In November 2008, Hartlepool was
judged to be the third best performing authority
Leadership, Legitimacy,
in England. Only North Yorkshire and Windsor Resource Allocation and
and Maidenhead had made Direct Payments
available to more people per head of population. Support Systems
See the graphic illustration above.
One of the ways in which In Control describes the
There has been much debate about difficulties transformed social care system uses a jigsaw. The
caused by overlapping funding streams. In four corner pieces of the jigsaw are leadership,
particular, some people have expressed a legitimacy (or understanding), resource allocation
concern that the implementation of Personal and support systems.
Budgets may disguise the shunting of costs from
adult social care to the Independent Living Fund We have already seen how, in Hartlepool in 2006,
(ILF). progress in the areas captured in these four corner
pieces had been mixed. It is important to end this
At 5.8 per 10,000, the number of people chapter by reflecting a little more on what this
receiving ILF funds in Hartlepool exceeds the meant in practice. We start by considering the
national average of 3.1 per 10,000. However, importance of exemplary leadership.

In Control’s Transformation Jigsaw
Leadership on her early days in the job. The first is her single-
minded conviction about the need to change
There are many metaphors for organisations things in a radical way, and to do this for the
and for the style of leadership that is said to clear and simple purpose of enabling citizens in
bring deep change. Some contrast ‘transactional Hartlepool to take control of their lives. The second
leaders’ (or managers), whose focus is processes is the equally clear conviction that this task could
and procedures, with ‘transformational leaders’, only be achieved through others, that is to say
whose focus is cultures and whole systems. through a rigorous and continuing scrutiny of
Beverly Alimo-Metcalfe and John Alban-Metcalfe, the job at hand and of the skills needed to move
for example, suggest that the transformational forward with that job, and then a process to
leader is someone who leads and develops others assess, nurture and deploy the human resources
by empowering them, delegating and developing available.
their potential and encouraging a questioning
attitude. The transformational leader has certain As Nicola put it: ‘Early on I saw that the staff were
important personal qualities including honesty, great but were very traditional. I spent some time in
consistency, integrity and decisiveness; and my early days getting to know people, spotting who
they focus on unifying the whole organisation were the rising stars, who was able to manoeuvre,
through setting and sharing a coherent vision, and who wasn’t. I set up the DP steering group to
and putting in place a process to agree individual provide some structure. I addressed their whys and
and organisational priorities and communicating wherefores and gave them a bit of encouragement.’
these with all concerned, including external She described how she managed ‘up’ as well as
stakeholders.1 ‘down’: ‘I spent a lot of time with the politicians.
I went to the Labour Group and showed the In
In Hartlepool, as we have seen, Nicola Bailey joined Control DVD, I talked a lot to Ged, the Portfolio
a fairly traditional Social Services Department, Holder and Paul, the Chief Executive, who was
albeit one with some positive attributes. Two brilliant and never once questioned the need for
things are most striking about Nicola’s reflections change. It’s about the culture you create...the

corporate culture as well as the departmental was more supportive when the going was tough
culture. Departmental culture is about getting for people. Recently I’ve stepped right back to see
things done, corporate culture is an encouraging/ how others take up the challenge, but now I see
hands-off culture.’ the need for a bit more direction again.’
Nicola also talks very passionately about the Julie Stansfield describes how setting the
need she saw at this stage to widen people’s scene and the direction of travel was one of
horizons. Like many local authorities, Hartlepool Nicola’s first key duties. Nicola had been a senior
can be somewhat inward-looking, and people are manager in a previous pilot site for In Control
sometimes simply unaware of what is possible. and so already knew the direction to take. She
‘After a couple of months we joined In Control and gave a clear steer on the direction of travel.
then the Total Transformation programme...this Some operational staff acknowledged the great
meant that staff here have had the opportunity benefits of having a Director with an-open door
to grow, and be exposed to lots of people they policy but added that she was certainly ‘no push-
wouldn’t have met otherwise. Having In Control over’. She would pay detailed attention to an
alongside us helped to re-energise the staff.’ individual family and unlock any systemic policy
that blocked an action that was needed and
Encouragement by the leadership caused made sense. ‘Nicola’s combination of common
Nicola’s ‘stars’ to rise. Operational leaders took a and business sense really helps families and
variety of complementary roles to achieve their individuals to get a better deal. I have witnessed
vision. Julie Stansfield observed how leadership Nicola focus on intricate detail of an individual
became quickly apparent at all levels: Jeanette family’s needs and then use the outcome as an
had a strong economic, systematic focus. Sarah exemplar of practice and utilise it to negotiate
focused on operational practice. Neil led on strategic implementation for policy.’
policy and planning process. Ewen, who was
there at the start of the journey, led strategic
policy. Though each had their own personality
and style of management and leadership, all had Legitimacy (or
a common goal of making things different and
better in Hartlepool. They all constantly compared understanding)
Hartlepool’s actions with what was happening
elsewhere. The question ‘Is that better than what The second corner piece is legitimacy, an
is happening here now?’ was a feature of steering understanding that is deep and widespread – the
group meetings. notion that the new way is the right way, and that
it is both permissible and necessary.
Thinking through and taking the first tentative
(but not too tentative) steps in actually handing As we have seen, legitimacy was much less evident
over money to people was important: ‘The in Hartlepool in November 2006. The picture
review team was our first port of call. Everyone was a mixed one, however, with high levels of
due for a review was told what their resource understanding and enthusiasm evident in at least
allocation was. Some older people said “Thanks, some of the really important places.
but I’ll carry on as I am” but were shocked to
know how much was spent on them. Others One comment on the staff workshop was: ‘The
wanted to get on with a support plan. Some score of 7 for Adult and Community Services
people with mental health problems jumped at reflects a very high level of commitment from
the chance and some said they were very keen departmental managers, but some further work to
to leave residential care.’ We give these issues be done in relation to “sign-off”. Low scores for the
further consideration in Chapter Two. whole Council and team managers highlight areas
where work is needed.’
In describing her part in the process, it is notable
how thoughtful and flexible Nicola has had to be: To unpack this a little more: the broader leadership
‘In the beginning, my role was to be very directive. from the Director and her management team was
I told them what was to be done. People hated it... in place, but they were yet to win over all of their
I gave them a hard time if they were not at the colleagues. There was a plan, however. Ewen Weir,
meetings. I was the project leader initially. Later, I the Assistant Director at the time, commented

that ‘The work planned and in progress with Elected that date these issues were well on the way to
Members is crucial to embedding, sustaining and being addressed.
protecting Self-Directed Support within the culture.
The intention is that there is an event in 2007 for
Members and that they are exposed to success
stories from Oldham and elsewhere.’ Resource allocation
The Members’ event was engaging, entertaining Self-Directed Support will not work without a
and interactive. Members were able to think robust system to put money into the hands of
about their own position and considered what ordinary citizens in ways that are fair, transparent
support they and their constituents might need and efficient. Too often a concentration on
around the development of Self-Directed Support. getting the Resource Allocation System (RAS)
Julie Stansfield recalls that ‘There was a real right becomes almost the exclusive feature
excitement in the room. Members were not only of the early work, such that councils become
proud to be part of this direction of travel, they preoccupied with the issue to the exclusion of
wanted to get more involved in taking it forward. all else. As we have already noted, the fact that
Their commitment further legitimised Nicola’s this was not the case in Hartlepool was not the
authority. Members at the event took away a broad result of financial systems that were already
understanding to pass on in their constituency.’ largely well attuned to the requirements of
SDS: in some regards, particularly the capability
Looking back, Sarah Ward reflects on this period: to capture detail about care packages and the
‘The work with Elected Members was invaluable. mapping work on unit costs, the systems were fit
We sent packs to those who didn’t attend events...it for purpose; but in other respects there were real
was all done from a values viewpoint.’ Operational concerns. In 2006, managers were worried that
and administrative staff were not merely informed the overriding importance given to Fair Access to
of the changes, they were involved: ‘We wrote the Care Services criteria would seriously undermine
basic process with the help of staff from different the Supported Self-assessment process, and they
disciplines, including admin, social care etc. All were had unanswered questions about how they would
mixed sessions. This gave them a good sense of accommodate charges for non-residential social
ownership, the feeling of having contributed to the care services in a person’s Personal Budget.
process. We also did a desktop Resource Allocation.
It was much more than a technical exercise. We These issues presented challenges and anxieties,
got a nice venue and, although we had lots of but they did not appear to be framed as
arguments, we came to agree the best way.’ insuperable barriers: in 2006 it was observed that
‘financial management of the Department appears
The lowest scores in the legitimacy section of the to be strong, and to benefit from integration with
2006 workshop were for team managers and for strategy and operations’. This was perhaps why the
other Council departments. There is little doubt, resource issues were given due weight, without
based on managers’ comments in 2009, that by obscuring all else. Jeanette Willis, the Principal
 

 
  


 
The RAS was developed using an iterative process of trial and sometimes error

Finance Manager/Transformation Lead, reiterates of information gathered from this analysis is

the importance of getting the fundamentals of the presented in the appendix to this report.
RAS right from the very beginning: ‘Sustainability
is assured if you build the RAS well in the first place. The group comprised 819 people. All had a
The way to do this is to use existing spend and take Personal Budget. A record was kept of individual
a good percentage off. Getting the Supported Self- financial allocations at different points in the Self-
assessment questions right is important as part Directed Support process:
of this process. This has to be seen as more than
a Personal Budget calculator. It starts by building Initial allocation: the amount the RAS
in the presumption of citizenship and framing the determined to be reasonable if no other
questions on that basis.’ From the earliest stages support were available to the person.
the key designers of the system in Hartlepool Adjusted allocation: the amount deemed
were thinking about Personal Budget holders in to be reasonable having taken into account
a broad context: they recognised the importance other support systems. This allocation was the
of the gifts and resources individuals and their amount the person could use in their support
families brought with them, and understood the planning.
importance of sustaining communities as the Approved amount: the amount that the
bedrock of viable support systems. Authority agreed once a support plan had
been produced and agreed.
Managers in Hartlepool were also clear that the
only way of testing a system of Personal Budgets At the time of writing, a full data set of all three
was through actual trial (and error), that is to figures was available for well over half the group –
say actually putting the money in the hands of some 548 people.
individuals who needed it. This was the only way
to produce real learning about what worked. 

As they allocated real resources to people, they 
were able to experiment with the underpinning 
systems and processes and think through the 
difficult outstanding issues – including the rules 
and regime for charging for non-residential 
services. Jeanette Willis sees the Hartlepool 
Contributions Policy as a major achievement – one 
which breached a significant barrier: ‘SDS meant 


we clearly needed to change the charging policy. itial j p
Practicalities dictate that if we assess someone for Personal Budget allocations

SDS holistically, then we can’t charge them for A
and not for B. So, in effect, we introduced means-
testing at the front end to ensure people were
paying what they could afford to pay and no more. Support Systems
People know what their contribution is going to
be before they do their support plan...we levy the Self-Directed Support is premised on good support
contribution at 25% of support plan cost, whatever systems that will help people to make plans and
they end up buying. The key message is that we – think through how best to get what is in those
the Local Authority and the person – are sharing plans.
the costs; hence we call their share a ”contribution”
not a charge. If they are not happy with what they In 2006, Hartlepool had done no work on support
have, the person can always use the money for planning, and the work on ‘brokerage’ was limited
something else. This works!’ (‘brokerage’ is defined here as a system to help
people get what is in their plan). Already in place,
Despite financial systems being well attuned to however, (as we have already seen) was a Direct
the needs of Self-Directed Support, understanding Payments scheme in the midst of a major re-boot,
individual activity within a large, complex and and a significant and active voluntary sector with
changing system has been challenging. In June a number of energetic user-led groups. There
2009, a snapshot analysis of the first tranche of is little doubt that these were and are helpful
Personal Budget recipients was taken. A summary conditions: a good Direct Payments scheme is a

means of demonstrating that the Local Authority A4E. Continued attention to the issue of financial
is attending to the expectations of those disabled brokerage was to be a striking feature of the
people who campaign for independent living. Hartlepool story over the next three years.
An active user-led sector means that there is an
opportunity to work with, and not just for end- In summary, Hartlepool’s support systems for
users, to co-produce systems that meet local SDS were rated slightly below the ‘good enough’
conditions and the needs of different groups. level. However, looking back from the perspective
of 2009, two things are striking: firstly, the
In some other authorities, these conditions may clear sense that managers had of the flaws and
not prevail, but there will almost certainly be other deficiencies in the system, and the equally clear
helpful factors which can be levers: a strong record plans they were able to draw up to address these
of person-centred planning across service areas, by introducing simple but thoroughgoing changes;
for example, or a good understanding of citizen- and, secondly, the sense over the intervening
defined outcomes. Neither of these features was period of systems and processes which remained
particularly well developed in Hartlepool in 2006. under constant scrutiny. This flexibility is a feature
What was important, however, was that these of the transformation process to which we will
(and other deficits) were recognised, scoped and return in later sections of this report.
factored into the programme plan. It was observed
at that time that the clarity of vision and broad
understanding among key managers of what was
required to make a success of the new system Key learning points from
would be bound to assist implementation. By the
same token, it was also observed that, in doing Chapter One
this mould-breaking work, managers would be
confronted with the anxieties of more junior 1. Principled leadership at different levels is the
staff (care managers, for example) who were most important single factor to create the
responsible for making the system work on a culture needed for serious change.
day-to-day basis. This proved to be an accurate 2. A clear vision of what must be done to create
prediction. a system of Self-Directed Support is vital.
3. Stay flexible, change things as necessity
A further aspect of support is what managers dictates and circumstances change.
in Hartlepool referred to as ‘financial brokerage’, 4. Work though others – senior managers need
services to help someone manage their money to lead and manage the staff team.
and purchase support. In 2006, there was already 5. Don’t obsess about any one aspect or set of
a recognition that in-house support services were issues. Move forward on a broad front.
inadequate, unable to help with payroll or develop 6. Get money to people early in the process.
‘indirect payments’, and a contract had therefore 7. Look to your strengths as an authority and
been tendered and awarded to the organisation build on these.

Chapter Two
The tools for transformation
The second section of In Control’s sketch map of the critical path to
transformation focuses on the tools required. These are perhaps best thought
of as the ‘minimum necessary’ tools. They may well not be all the tools
needed for the re-design of systems and processes, and no doubt they can be
described in many different ways (as a quick overview of the many PIDs and
project plans from across the country will testify). But from any perspective,
this is the engine-room of the new vessel – or to use a more contemporary
metaphor, the machine code that specifies and configures the new operating
system. Some of the changes follow closely from those discussed in the first
chapter and we will aim to avoid repetition.
Economic systems process to manage discharges from hospital (see

Chapter Four for more on this aspect).
We have already made a few observations about
Hartlepool’s financial systems and about the The Department sees the allocation of resources
early work on the RAS, on contributions and on through Self-Directed Support as one stage of
the systems needed to manage and monitor a journey to establish personalised supports for
Personal Budgets. Getting the RAS into a state in all who need them. The needs assessment and
which key people feel it is ‘good enough’ to begin Support Planning process consider the impact a
allocating money is a crucial aspect of the early person’s disability has on their life, and resources
work. Managers in the Borough were clear that are allocated taking a long-term view. Individuals
this is part – but only part – of the basic system are not expected to plan in times of crisis and
architecture needed at this stage. Jeanette Willis, various provisions such as rapid response nursing,
Principal Finance Manager/Transformation Lead, intensive homecare support and transitional
re-iterates that the Supported Self-assessment residential care are used to enable an individual
process and the Support Planning arrangements, to get to a point of stability where they can make
taken together, are central to the task of decisions about the longer term.
managing resources in ways that are both prudent
and responsive. Very early on, Hartlepool established the need
to capture as best they could (given the lack of
The Supported Self-assessment is the means by off-the-shelf solutions) the economic impact of
which people begin to define and plot out a profile a move to Self-Directed Support. This is done in
of their needs and (often for the first time) begin part through the Risk Enablement Panel. As well
to think in a systematic way about what it is they as helping with the technical task of data capture,
want from life and how they might take control. the Panel process focuses the minds of managers
The Support Plan is the key vehicle for taking this and practitioners on the use of ‘resource’ – not just
thinking to the next stage and for providing the of money.
keepers of the public purse with a costed proposal.
Equally important for many authorities (and
Having a clear overarching operating system is probably increasingly so in the light of the
vital from the outset. Hartlepool already had a gloomy state of public sector finances) are
system for early intervention and reablement systems to record, track and profile spend; and
with a co-located Multi-Link team and a rigorous systems to make use of the data produced

and of demographic and socioeconomic trend get money into the bank accounts of individual
information to predict future demands on citizens as early and as quickly as possible – and
authorities’ budgets. the systems and processes will fall into place
around this imperative. At the other extreme are
In 2006, managers in Hartlepool were confident authorities in which the re-design of systems and
about the Authority’s systems for recording spend processes comes first, and only when these have
and for producing and interrogating reports. This been signed off as fit for purpose will the numbers
confidence, when combined with the prudent of people receiving a Personal Budget exceed
approach to RAS construction described above, those in a small pilot. Hartlepool, in common
provided a reassuring foundation in designing a with many of the early adopters, has inclined
new system of Self-Directed Support. This did not towards the first approach. However, managers
mean that Self-Directed Support in Hartlepool was in Hartlepool have not ignored systems issues.
designed for the overriding purpose of containing Instead, they selected the systems which needed
costs – the Director and several other senior early attention and focused on those, whilst using
managers state very clearly that this was not the the actual allocations as a live experiment, a test
case – but it did mean that the monitoring and of the evolving operating system which could
profiling of spend could be achieved relatively provide feedback to change the systems further.
straightforwardly. This is not the same as saying This meant that the size of the task appeared
either that the budget was adequate (it was not much less daunting and, in the early days, energy
and there were several years where it marginally was focused on continuously improving those
overspent) or that the Authority can accurately things that needed most attention.
predict the demand for adult social care services
for the foreseeable future. Jeanette Willis says ‘We What did this mean in practice over the three
don’t yet know if are attracting more people to use years or so over which Hartlepool has been
social care services because of SDS, it’s very hard developing Self-Directed Support? Which were
to tell and it is a worry.’ However, she says that the areas that received priority attention? See the
Hartlepool systems can, unambiguously, show real table on the facing page.
value for money: ‘We can say that we are able to
guarantee every penny of value in Hartlepool. We
couldn’t say that with the old system.’
Monitoring of outcomes
This is probably as far as any authority in England
has been able to get with these important issues and costs
to date. The Government and the Department
of Health are preoccupied with the performance A compelling case for personalisation must be
management of local authorities as they introduce backed by a strong evidence base. This evidence
personalised support services. ‘What is important’ needs to address a wide range of audiences with
says Jeanette ‘is how we now make use of the various concerns.
information from our systems for this performance
management and reporting.’ In brief, these include:
national thinkers, policy makers and leaders,

those with an interest in social care and in
New systems, processes and wider public services
procedures local politicians and community leaders

ordinary citizens needing support and their
friends and families – including unpaid carers
Local authorities have different ways of those involved in social movements, such as
approaching the task of reviewing and revising the Independent Living movement
their systems, processes and procedures to make economists and business leaders, those with
them fit for the purpose of delivering Self-Directed an interest in efficiency and value for money
Support. staff in social care and others whose
livelihood depends on an income from
At one extreme are those authorities which think support services; some are employed by local
the best way to test Self-Directed Support is to authorities, others by the private sector, others

System, policy or procedure to How Hartlepool Borough Council addressed this

be changed
Addressed early through desktop exercise and then as first allocations
were made. A priority. Remained under review throughout the period of
Develop and test Resource implementation, but alongside the clearly articulated view that RAS is a
Allocation System means to end, and that it is unhelpful and possibly illegal to change RAS
levels for existing Personal Budget users to manage emerging budgetary
problems.
Addressed early. This was seen as a priority equal to RAS work. Clear
Develop and test Supported Self- perspective that the assessment process would always require support
assessment Questionnaire from Local Authority staff, and that getting the questions well framed
was a key task.
Develop risk enablement framework Addressed early. Linked to Panel process – see below.
Addressed early. Support Plans were seen as drivers of the process and
were signed off by Assistant Director/Director. Remit of Panel has been
reviewed and amended as processes have become more mature. ‘Panel is
Agree Panel process
seen as a learning set for cultural change’ (Sarah Ward). Panel now looks at
cases where the point score is greater than 50, or where there is a large
discrepancy between proposed cost and those of existing services.
Develop legal agreement for Addressed early.

transfer of money in a Personal
Budget
Addressed fairly early. The old charging policy was under review before
the decision to operate a system of Self-Directed Support owing to the
inequities arising from innovative use of Direct Payments. It took some
time to devise a policy that was fit for purpose but, when completed,
this was seen as a crucial step. Means testing is at the ‘front-end’ with
individuals knowing quickly what their maximum contribution would
Write Contributions Policy
be. All contributions under the policy are equal to the cost of the support
plan, up to the amount the individual is assessed as being able to pay.
The Council currently shares 25% of the cost of the Support Plan. The
contribution policy operated in Hartlepool dovetails with the recent
national consultation and subsequent National Guidance which is to be
fully adopted by all authorities by March 2010.
The Department is very clear about its commissioning role, and about
Review commissioning framework
its purpose in commissioning for outcomes. Commissioning issues have
with providers been influential in shaping the whole programme.
Addressed fairly early. Seen as important to get this right because
Agree procedure in relation to of the potential to de-rail the process and to act as a distraction. The
Fair Access to Care Services and Department worked hard to support third-sector organisations that were
eligibility in a position to meet ‘low’ and ‘moderate’ needs for those people not
eligible for a service from the Authority.
Addressed mid-way though the implementation process. Seen as
Agree framework for Support Plans important, but the Authority was very conscious of the need not to
impose a structure on people.
Amend requirements from ICT, Relatively strong basis helped and issues were picked up through the life
including portal and management of the programme implementation.
information
Audit arrangements for DPs addressed as part of the pre-existing DP
Amend audit arrangement for DPs/
scheme prior to full SDS. Internal Audit staff were involved in the process
Personal Budgets from an early stage.
Public awareness was an on-going work-stream through the life of
Provide public information about
programme. A formal communications strategy was agreed at the mid
SDS point of the programme.
Re-design the review system Addressed early and re-visited as more people received a Personal Budget.

by the voluntary and community sector. and the Institute of Public Care’s initiative to
develop commissioning.
A large part of the success of In Control in leading collected a series of Personal Budget stories
the movement to persuade Government that SDS (very short written personal accounts in the
should become national policy (it did through the first person) recorded with the permission of
Putting People First Concordat) can be attributed the individuals concerned and used by the
to the emphasis placed on the range and depth of Authority to help in the process of publicising
the evidence gathered from the early pilots which the new system. Two examples are given in
sought to address this wide spectrum of concerns. the boxes below. These stories are probably
Trailblazing local authorities such as Hartlepool the most important testimony of all –
have replicated this focus on the monitoring evidence that the lives of ordinary citizens can
of outcomes and costs, and in particular on the and do change as a result of SDS.
capturing of personal accounts of transformation. brought together corporate think tanks to
enable scoping the lessons from Self-Directed
Hartlepool Borough Council has worked closely Support to a corporate self-efficacy agenda –
with In Control in this area. Joint initiatives facilitated by Steve Jones and Julie Stansfield.
include:
A piece of work led by John Waters of In Mrs C.

Control to gather and analyse information
from Supported Self-assessment ‘It is nearly a year since my first assessment
Questionnaires and Quality of Life self-reports for support from you…following the big do I
(reports are available on the In Control had when my head was in the shed…. Having
website in relation to a number of authorities. support has given me my life back. I am able
The Hartlepool evaluation will be published in to go out now. I can travel on buses again and
late 2009)2. I have been all over. X has been a life-saver. She
A series of visits by Andrew Tyson of In Control does everything she can to help me. The house
to assess readiness for SDS and subsequent is clean and presentable – just as I like it. When
progress against this baseline. This is the basis I have bad days, she is able to support me in
for the current report. every way. I would be lost without the help.’
Work with Julie Stansfield of In Control and
others to assist staff to record and celebrate E
achievements and to create a vision that can
E is a 20 year-old lady who has significant
be renewed and updated.
learning disabilities. E lives in Hartlepool in her
parents’ home. E’s mother says that, through
In addition, the Borough Council has:
the personalisation process, E has been able
to access innovative short breaks of her choice
encouraged its staff to reflect on and write
instead of traditional respite care services.
about SDS as part of their professional
These breaks have included trips to Newcastle,
development. This has led to a piece of
Whitby, Cadbury World and Chessington
research for an MBA by Geraldine Martin, a
World. The Personal Assistants have supported
senior manager in the Department in addition
E for some time.
to a number of other university dissertations.
worked with Julie Stansfield of In Control E’s mother thinks that the PAs have enabled E
in her role as Site Support for Total to have friends. E’s PAs are of a similar age to E
Transformation using her in a critical friend and are able to engage and connect with her
role and drawing on her experience of change about the latest fashions and music. This has
management. led E to move on to exploring and experiencing
made available key leaders from Hartlepool the beauty therapies that most teenagers like.
who have participated in a large number of E has said that she likes to go away without
national and regional fora and gatherings. mum and dad and she likes to go to the
sought and capitalised on a number of theatre and see shows. It would appear that,
other development opportunities including through E’s In Control Budget, she has been
Turning Point’s Connected Care project to supported, enabled and given confidence to
build community capacity (see Chapter Four)

experience a quality of life that every teenager that so few key people complete the tasks that
would like to emulate. E’s mother has said that some other authorities seem to need multitudes
‘E now has the opportunity to lead a normal of people to process. We have to bear in mind that
life’. She feels that her daughter now has the there were helpful conditions already in place:
freedom to do what she wants to do. No-one that is to say Hartlepool had already developed
tells her what to do and where to go. E now more streamlined processes before they started
has choice and independence.’ to implement SDS. Other authorities would need
to pay conscious attention to streamlining their
existing systems and protocols to create economic
These stories and other reflections have been efficiencies and processes that quickly get resources
critical in building and maintaining a sense into the hands of people who need support.’
of excitement and momentum within the
programme and in persuading a widening circle
of people that the changes are necessary and
worthwhile. Each of these diverse initiatives Key learning points from
addresses the issues differently, but what
they have in common is the central place the Chapter Two
programme allocates to the values of choice,
control, citizenship and community. 1. RAS, Supported Self-assessment and Support
Planning are all aspects of the ‘assessment
This is particularly important when it comes to the process’ and are tools to secure efficiency as
monitoring of costs: the case is made not that SDS well as effectiveness.
saves the Authority money or that it is a means 2. It is very difficult to predict whether
to (on its own) bring an overcommitted budget demographic changes and increased
into line. Rather, the argument is that, if done attractiveness of SDS will cause longer term
thoroughly and systematically, SDS is less wasteful budgetary difficulties but, notwithstanding
than traditional systems, that it targets public this, it is still possible to build a sound system
money more effectively and more directly to those that is fairer, more transparent and less
citizens and communities where it can have most wasteful than the old system.
effect, and that – when set alongside the improved 3. There are a number of system, policy and
outcomes demonstrated – it provides better value procedure changes that need to be considered
for taxpayers’ money. when moving to transformation. Prioritisation
and sequencing of these changes need careful
One of the key issues that Julie Stansfield noted local consideration.
while working with Hartlepool was ‘a lack of 4. The monitoring of outcomes and costs is a
bureaucratic procedures’. crucial aspect of transformation programmes,
to build local support and satisfy multiple
She says ‘Hartlepool has relatively little red tape stakeholders.
–no middle managers placed between the person 5. Hartlepool is very streamlined in both its
and the exercise of their Personal Budget. Processes management structure and its procedures.
are very streamlined and effective. Decision- Other authorities have to keep in mind that
making processes around individuals are swift and they may not be starting from the same
a credit to the Authority. In Hartlepool, I’m struck baseline.

Chapter Three
Changes to the way support is provided
To achieve transformation it is not just the ‘machine code’ of the local
authority ‘operating system’ that needs to change. Transformation also
requires the translation of that code into useful applications and the creation
of a user-friendly interface for those applications. It requires, in other words,
a radical review and revision of how the local authority makes use of the
money at its disposal to provide support for citizens.
Traditionally, what authorities have done as authorities move SDS from the margins to
with their money is, of course, to use it to the mainstream. It is clear in Hartlepool and
assess people’s needs and then either provide elsewhere, as was demonstrated both by the In
services themselves to meet those needs or to Control Phase 2 Report4 and by the IBSEN5 report
commission others to provide services, either on the Individual Budgets pilot schemes, that
in blocks or sometimes on a spot basis. Simon there are many Personal Budget users who do not
Duffy has described this approach as the giving have the time, energy or inclination to manage a
of ‘professional gifts’.3 It was dissatisfaction with budget themselves. It is critically important that
the fundamental features of this system – the fact these people are not excluded from the process, or
that, for the most part, it led to services that were treated as second-class Personal Budget users. In
pre-packaged and undifferentiated – that led to Hartlepool, as elsewhere, there is now a range of
what became Self-Directed Support from 2003 different control mechanisms to enable everyone
onwards. to control (but not necessarily ‘manage’) their
Personal Budget. They can do this in their own
There are a number of changes that In Control, way: directly (as a Direct Payment); or through
based on its work with more than three quarters family and friends; using a professional; or a
of English local authorities, has identified as key to service provider; or an independent organisation;
fundamental system transformation. Hartlepool or a representative.
has made significant progress with each of these,
and this progress is described in the sections that Individual Budget
follow.
1 2 3 4 5 6
Direct Payments and other

ways of managing the
Direct Indirect Trust Brokered Individual Care Managed
Payment Payment Fund Fund Service Fund Fund
money
We have already noted the important part played Different ways to control a Personal Budget
by the renewed focus on the Direct Payments
scheme in 2005 and 2006 when Nicola Bailey The IBSEN report suggested that this was
took up post as Director. In 2009, Direct Payments particularly important for older people and for
remain at the heart of the SDS process in the those who had been using services for some
Borough, but as one of several options on offer time. This suggestion seems to be borne out in
to citizens. This marks a crucial development Hartlepool where, as one manager observed, ‘Not

everyone wants to be innovative and creative and Probably the single most important attribute of
stick out of the crowd, many older people in the a good Direct Payments scheme, one that sits
town are happy with the homecare services on offer comfortably within the values inherent in Self-
and just want a bit of help...many don’t want the Directed Support, is that it is not restrictive in
bother of a Direct Payment.’ terms of the way the budget can be used – what
can be bought – so long as people are successfully
It is also important that Direct Payments meeting their assessed needs.
themselves evolve. Simon Duffy, the former CEO of
In Control, worked with colleagues in Yorkshire and There are now scores of examples of imaginative
Humber region to produce a guide describing how uses of DPs in Hartlepool to bear out how this
Direct Payments schemes should be made central can work. Some groups have pooled elements of
to the wider system of SDS. their budgets to form, for example, the Hartlepool
United Disabled Supporters Association and the
The introduction to the guide says: Roaring Mouse Theatre Group (featuring a Pop
Idol version of In Control’s Seven Steps!). There are
‘Direct Payments schemes are an essential part of also allotment groups, a walking group and an
Self-Directed Support: Direct Payments is where arts group. People have purchased large-screen
Self-Directed Support began and they remain an TVs, golf club and gym memberships, a dog and
important option for people who are managing much more that would once have been beyond
the money they are entitled to. It is important the pale. There are also many more lives that have
that the practical systems that support Direct been transformed through making use of Direct
Payments are extended and amended to fit with Payments to manage fairly traditional support
Self-Directed Support; it is also important that arrangements, often buying home care services.
people who currently use Direct Payments get Such services may be ‘traditional’ but they are now
the opportunity to benefit from the flexibility of necessity much more personal.
and freedom inherent to Self-Directed Support.
Reconciling Direct Payments with Self-Directed There are also some key technological
Support is an easy win for local authorities who developments that can support people to
are members of in Control – particularly for those ‘budget mind’. In Control has strongly supported
who already have well established Direct Payment shop4support which provides this function
systems.’6 electronically and Jeanette Willis has been
working with Controcc which is a locally developed
In Hartlepool, the structures and supports for way of achieving some support outcomes.
people who do want to make use of a DP have
been kept under review as the wider system has
been introduced. For example, a senior manager
spoke about the contract for the DP Support External providers
Service: ‘People aren’t any longer required to use
the contracted Support Service to manage their Hartlepool Borough Council was a ‘commissioning
Personal Budget. There are now three providers, organisation’ some time before Self-Directed
rather than one. The individual can buy elements Support was on the agenda. What is more, as
of the package, including financial support, outlined in Chapter One, that commissioning
recruitment, assistance with employment and so did not produce – for the most part – ‘blocks’
on. The full package costs £550. Some people have of service. These factors have helped to provide
learnt to manage their own DP over time and a helpful environment for providers to begin
dropped the support service.’ The manager went to think about and transform what they do, in
on to observe that the system worked better response to what can be a frightening set of
now that the support services were not free, and imperatives from Government, Local Authority and
that people had to weigh up the benefits gained newly empowered citizens.
against the cost to their budget, but that ‘...we
are still not sure that we have got it right and they Before sketching how this process is beginning to
get all the support they need.’ It is intended that work in Hartlepool, it is worth making the point
information from the review process will help to that In Control has now worked with providers
paint a picture of what is now needed to move DP in local authorities where such conditions do
support to the next stage. not prevail. In fact Self-Directed Support has

many of its roots in the initiatives from provider are concerned with is how it affects their life. So we
organisations themselves, in Glasgow and North don’t necessarily share all the detail.’
Lanarkshire – what have now become known
as Individual Service Fund (ISF) arrangements Many of the mechanisms to manage this new set
– where pre-existing traditional contracts and of commissioning arrangements are only now
blocks of funding were split into Personal Budgets being developed or made available. The Authority
to be managed by the provider, guided by the has commissioned a new contract management
support plan of the individuals concerned.7 It and financial assessment management
is becoming evident in some places, especially information system as part of their overall ICT
where organisations work across local authority operating system. The system, called Controcc
boundaries that transformation can be very (Oxford Computer Consultants – OCC), has the
effective when it is provider-led in this way. ability to generate graphical reports to show
commitments, costs and outcomes. Further work
In Hartlepool, while conditions do seem is underway in partnership with OCC to develop
favourable, experience suggests that there is still a fully interactive personal budget monitoring
a need for considerable further work. Core costs area which will allow individuals to access via
for some contracts have had to be re-structured as a customer portal. They are also considering a
they move to an ISF-style arrangement, and new Quality Rating system by individuals, which will
gaps in the pattern of provision have inevitably encourage and gather feedback about specific
surfaced – for example, a broader based peer services.
support service and a new advocacy service are
needed. There have been three personalisation Managers interviewed in summer 2009 were
events that the Council has led with providers, and guardedly optimistic about these developments.
much detailed and in-depth work outside these There are still unresolved issues and concerns: ‘We
events to shift the roles and expectations of all now need to create the market place, with sufficient
concerned. choice for everyone to live the life they choose,’ said
one manager. ‘It’s still difficult to free up money,
This work has focused on service level agreements, and there is still something of an over-reliance on
contracts and monitoring arrangements that have residential care.’
become centred on a review of the individual’s
expenditure from their allocated budget. As a
result of the changed expectations, providers’
views of the best way of providing support have Social work
shifted; a couple of schemes have seen the need
to move away from Care Quality Commission In Control has been clear about the importance
registration, an adjustment that can be positive of social work in the transformed system. (We
for the tenants, but which, of course, needs to have tended to talk about ‘social work’ as the
be carefully managed ‘and is being handled in profession and ‘social workers’ as the people doing
pragmatic little steps’. it, even though some of the staff concerned are
not professionally qualified; ‘care management’ on
A piece of work is also in hand to rationalise the the other hand is the gate-keeping function in the
different funding streams (particularly Supporting old system.) In Control argues that social workers
People (SP) and Independent Living Fund) which are not uniquely skilled, or indispensable in a
contribute to the commissioning of services, all fully functioning SDS system. Rather – and very
of which currently operate to different rules and pragmatically – in many authorities, the presence
monitoring regimes. This has involved a lot of of an educated and experienced cadre of social
painstaking work to unpick the different funding workers, whose professional value base closely
contributions that make up each individual’s mirrors that of SDS should be seen as a valued
support package. This process has been assisted by asset for the difficult road to personalisation. In
good local working relations with other agencies, Control has worked with partner local authorities
and has now begun to bear fruit. Sarah Ward says to analyse the tasks, skills and knowledge required
‘We’ve done great assessments with SP people – we to assist people on the path through the seven-
asked a lot of hard questions about use of SP. End step process. This has revealed that social workers
users don’t need to know some of this detail around make an important contribution at each step,
finance, and the makeup of packages. What they particularly when individuals are in difficult

circumstances or when they lack friends, family or residential care”. Everybody fits into a box. People
other natural support.8 were over-assessed. It was like a sausage-machine
approach. It made me feel pretty demoralised really.’
In Control is clear that, in order to capitalise on
the wealth of knowledge and experience that Views on SDS were in some cases enthusiastic,
social workers bring, local authorities, together but in many cases cautious. Often the caution was
with educators and trainers, need to adjust mixed with anxiety: ‘The stories I’ve heard about In
how the social work task is configured and how Control just seem a bit worrying...I feel like I’ve been
the profession positions itself to deliver choice sold something that’s not possible at the minute.’
and control, whilst enabling people to remain ‘People aren’t clear on what the ethos of it is and
supported safely within their own communities. whether or not it’s safe to let it go – like a dog on a
leash, dare you let it go?’ ‘I don’t feel I’m convinced
In Hartlepool, there is a particularly interesting yet, you hear the stories and you see the videos and
instance of how this issue can play out. In her MBA I think to myself “how have they got away with
dissertation, Geraldine Martin, a senior manager in doing that?”’
the Authority and a former head of the social work
service, addresses the question: ‘The current care Some people were more optimistic: ‘I’ve got a
management model of support is being radically brother who has learning disabilities so I can see
transformed into a model of Self-Directed Support both sides of the story. If In Control takes off the
that focuses on the personalisation of social care. way the story goes, according to the principles of it,
In the traditional model social workers are care I could see my brother having a much better life –
managers who assess, plan, monitor and review more freedom, more control, and more choice.’
care packages for people. The professional remains
in control of the process. With the SDS model, What is striking about these accounts is that
people complete a self-assessment form, they most of them refer to a system that they have
are allocated a budget and they then draw up a heard about (and which has been ‘sold’ to them)
support plan to meet their perceived needs. People but not yet actually encountered in practice. In
may or may not choose to use social workers to 2009, Geraldine Martin emphasises this point
assist this process.’9 and says that, since the full introduction of SDS
in Hartlepool in December 2007 when SDS was
The Local Authority, in taking the model proposed offered to all new customers and on review to
by In Control, asks its social work staff to amend all existing ones, the views of social workers
not their core values or their professional identity have changed and become very much more
as skilled helpers, but rather to rethink how they positive. Many workers, she says, now talk about
make sense of these values and identity, and in SDS as helping them to re-connect with their
particular how they should discharge their duties basic motivation for entering the profession.
such that citizens gain control of their lives. This Many say that morale has been raised by the
is a subtle, difficult and anxiety-provoking change new freedoms from bureaucratic form-filling
for many people whose professional commitment and gate-keeping, and that they have been
and purpose may seem to be called into question. inspired by the capacity of citizens to plan and
realise those plans. Some have clearly found the
Geraldine’s research was conducted in 2008. The changes challenging: Nicola Bailey talks about a
purpose was to ‘discover the meaning that social strategy to nurture those who were particularly
workers give to SDS and their role now and in the sceptical and preferred the pre-existing system
future’. She analysed questionnaires from 29 social by consciously mixing up teams across the old
workers (69% response from an initial distribution ‘client groups’, in part so that workers in more
of 42), and carried out face-to-face interviews traditional teams are exposed to the benefits of
with seven practitioners. This process revealed the new approach.
that many social workers remembered the high
ideals they had held on qualifying as a social The box below contains an update from
worker, but also that they believed their ideals Geraldine Martin about social workers’ views a
were compromised by a care management system year on from her initial research. It throws an
that seemed to process people with little regard interesting light on how the real experience
for their individuality. ‘People were fitted into a of SDS – as opposed to the hopes, fears and
box: “You’re home care, you’re day care, you’re fantasies – can change a culture.

Update on the social workers’ views of SDS twelve months on

from the initial research
The social care staff appear much more confident people’s right to autonomy in respect of personal
in working with the values, systems and assistants employed by people not requiring CRB
processes around personal budgets. checks.
Looking back, the majority of social care staff The issue of FACS criteria being set at substantial
acknowledges the real challenge associated and critical continues to feel like an unwelcome
with the ‘big bang’ rather than the ‘piecemeal’ barrier to driving forward the ‘preventative’
approach of introducing personal budgets agenda. There is also a sense that choice around
across social care in Hartlepool: ‘It felt like being services in the community is still limited and,
dragged along by wild horses’, ‘disempowered’, as one social worker said to me: ‘There is not yet
having to ‘rethink the model completely’. The great evidence of entrepreneurial business activity
majority view now is that it has been worth it. on a micro level. I suppose it takes time to change
One social worker recently said ‘We are really a whole culture’.
doing person-centred practice now and it is great
The overall view of the social care workers is that
getting to know life stories, histories and helping
personal budgets are starting to work well and
people work out what they want to achieve in
that this model is a vastly better framework for
their lives’. Another social worker said ‘I am more
achieving personalised supports that help to
comfortable now thinking outside the box to
deliver meaningful outcomes with people.
promote good outcomes. I feel safe in doing this
as the social work bit lets me really communicate Challenges remain but all the social care staff I
with the person rather than following scripted have spoken to say that they are more confident
forms which can get in the way. Many of the working with personal budgets and they have
support plans now are outcome rather than a clearer and more optimistic view of their role
process-focused and this is a real change from going forwards.
the earlier support plans which often resembled
traditional care plans.’ Recently one social worker said to me: ‘The
public now seem much more aware of what a
There is less anxiety now about the role of social personal budget is. I take numerous phone calls
workers within personalisation and a better from people or their carers who have heard about
understanding of where this role fits into the personal budgets and want to know a little more
new care and support paradigm. The weekly about them or how to access one. Often I am
panel meeting evidences many creative support told this is through word of mouth from satisfied
plans and a real sense of satisfaction when people in receipt of a personal budget.’
outcomes are shown to have been achieved at
review.
Geraldine Martin, Head of Service, Hartlepool
Social workers and social care workers continue Borough Council / North Tees and Hartlepool
to wrestle with their ‘duty of care’ versus Foundation Trust. August 2009
The evolution in the views of social workers in Internal providers

the Borough is something which has echoes in
other authorities: for the most part, before they The next element in In Control’s critical path to
encounter SDS, social workers are worried and transformation refers to the changes that an
sceptical about many of its claims – there is a Authority’s own provider services need to make.
marked tendency to adopt the ‘it’ll never work As we have seen, by 2005/6 Hartlepool had very
here’ view. When they are forced (as is usually the few such services, and this element has not
case) to begin working in a reformed system, social featured highly in the programme in the Borough.
work practitioners become some of SDS’s greatest Nevertheless, a few general observations can be
champions. made about the issue.

Part of the success to date in Adult Services in Micro provision

Hartlepool can be attributed to the fact that the
Authority is small and the culture is largely one in One feature of the market for social care in the UK
which people see themselves as working to make since the 1990s is that it has become increasingly
things better for their community, their family, dominated by large enterprises, often backed by
friends and neighbours. This sense of purpose is City money, and with service models less focused
much harder to generate in a large county council on choice and control and more on the need to
or a diverse London borough. But, in any authority, keep costs down. This is, of course, something of
it is possible to make the change, and those a caricature, and it is certainly more the case in
leading the change must be clear from the outset some market segments than in others. However,
– as Nicola Bailey in Hartlepool was – that the there is little doubt that the need to control costs,
introduction of personalisation is not just about together with some of the contracting models
tinkering with Resource Allocation systems, or promoted by central Government, has induced
amending the job descriptions of care managers. many local authorities to welcome providers under
Rather, it concerns how each member of staff in large block arrangements that deliver high volume
the authority (whether working in home care, day at low unit costs.
services, residential care or any other part of the
service) sees their relationship to the citizens they Whilst the worst of such arrangements are clearly
serve, and how they work with them to achieve antipathetic to personalisation, In Control has
control. This is just as true for a large authority always been clear that it is not opposed to large
with many in-house services as it is for somewhere provider organisations as such: large organisations
like Hartlepool. may bring with them new capacity and resource
to develop services, and there are many examples
A second general observation concerns the nature of large third sector and other not-for-profit
of local social care markets, which, more often providers that embraced SDS from the outset
than not, feature a mix of in-house and external and are now able to demonstrate significant
providers. For many years now, providers from the progress. The Individual Service Fund model is now
private and third sectors have complained bitterly being used in many places to de-construct block
about the fact that they are asked to compete arrangements, with great benefits for individuals.
with local authority services on an unequal basis,
sometimes where in-house services are ‘free’ to This said, In Control takes the view that if we
care managers (because they have been, in effect, are to make a success of personalisation, the
pre-purchased), sometimes where there are other balance of provision in social care markets is
incentives to buy an authority’s own services. now too strongly in favour of large providers.
Many Personal Budget users opt for solutions
The effect is not just on the independent sector that are highly personal to themselves, their
providers themselves and on the market, but circles and networks; solutions that are rooted
on individual citizens who are often channelled in support plans that draw on the real wealth
towards the local day centre or home care service, of their local communities, and which do not
without any real choice in the matter. Now, in depend at all on traditional day care or home care
authorities that are beginning to introduce SDS services delivered by ‘social care providers’. An
and to allocate Personal Budgets, this anomaly important part of the commissioning task for local
is necessarily being addressed. Councils have to authorities then is the promotion and stimulation
provide –at the very least – nominal prices for of small services that can meet these emerging
in-house services, so that Personal Budget users needs. These services are sometimes referred to as
can make real decisions about what is best and micro provision.
how much it is worth to them. This means that,
in many parts of the country, local authority The organisation NAAPS10, which has researched
providers are considering their remit and role the barriers and opportunities in this area, says
with a new rigour: many are opting to provide that ‘Micro social care and support enterprises
more specialist, focused services that sit more established and managed by local people are in a
comfortably both with the skills and interests of good position to deliver individualised services and
staff and what the market requires. This process, are vital elements of a diverse market... Micro social
whilst sometimes painful, can only be good in the care and support providers are independent of any
long run for all concerned. larger or parent organisation and often deliver the

service themselves without employing staff, or have significant challenges and some of them require
a small number of paid or unpaid workers. Most adjustments to national legislation and regulation.
providers of micro services see their operation as The Hartlepool experience, though, is beginning to
being an ideal size and are not aiming to develop show that there are local initiatives which can also
their enterprise in order to support more people or make a real difference.
to expand into a different area.’
NAAPS goes on to point out that ‘Every local

authority has existing micro providers in their Key Learning Points from
area but they can be hard to identify and engage;
they face growing regulatory, legislative and other Chapter Three
barriers and in general their numbers are falling.
In every area there are entrepreneurs who would 1. It is critical that a range of control options is
be willing and able to set up new, innovative and available for people to manage their money.
highly personalised service options if only they 2. Direct Payments schemes need to develop
knew what people needed and had the information to allow people to use their budgets as they
and support that they need to do so with choose and permit creativity. Support services
confidence. There has been a view that new services are needed that are flexible and able to offer
will simply emerge and existing services adapt and tailored support.
thrive in response to the growing number of people 3. Local authority commissioners need to work
with their own budgets. Evidence...suggests that with providers to find ways to build on and
this does not happen so easily and in most areas adapt contracts so that the needs of citizens
the local market is becoming less rather than more are central. The Individual Service Fund model
diverse.’ 11 will be important in this endeavour.
4. Social workers should be seen as an asset to
In Hartlepool the situation is not markedly SDS. Their role and remit needs to be reviewed
different from elsewhere and the comment about in line with In Control’s Seven Steps and with
the limited evidence of ‘entrepreneurial business local priorities and circumstances.
activity on a micro-level’, from the social worker 5. Local authorities need to review their own
in Geraldine Martin’s update (see above) suggests provider services. Personal Budget users
that there is still some way to go. However, need to be able to buy in (or not) with their
there are now some signs of ‘demand-led’ micro- budgets.
enterprises beginning to develop in the town 6. Micro-provision is an important part of the
as Personal Budget users exercise their new local market, and authorities need to take
purchasing power, and form their own micro-social steps to stimulate the development of micro-
enterprises or create opportunities for others to enterprises and remove barriers to setting
supply services to meet needs. The Community them up.
Interest Company set up through the Connected 7. Electronic marketplaces are developing.
Care project is described in the next chapter and This development not only supports local
the Council is also working with local third sector authority commissioning and market
organisations to develop a Centre for Independent management but also solves and supports
Living in the town. The intention is, in part, that key issues such as budget minding, images of
this Centre becomes a vehicle to stimulate the what is possible and information/community
growth of local micro enterprises. These are catalogues to self-funders.12

Chapter Four
Looking ahead
The first chapters in this report look back over the last few years and provide
a brief history of Self-Directed Support in Hartlepool.
This chapter looks ahead and considers some of the wider issues now facing
politicians and managers. There are a number of ways of summarising these
challenges: one is to look at the diagram of four quadrants in the Putting
People First programme.
in voluntary activity; and they live alongside and

support others as members of communities of
various sorts. If we look at the world in this way, it
is apparent how narrow Self-Directed Support and
social care services can seem.
The personalisation agenda is anything but

narrow in conception though and Nicola Bailey
and several of her senior managers in Hartlepool
recognise this as the next strategic challenge in
the Borough. In conversation in June 2009, Nicola
said that there are now four key issues facing
Putting People First’s four quadrants the Borough: children and family issues, building
community capacity, information systems and
‘how it all connects’. One of her colleagues said
Self-Directed Support is largely a means to address ‘There is a wider Putting People First agenda, now
the issues raised by the bottom right quadrant: we have to focus our energy on stopping people
choice and control. If done well, the introduction needing services...we need to work with the PCT on
of SDS involves processes to make use of the health issues and to join up more with the other
community’s wider social capital. It enables statutory agencies like Education and Housing.’
people to make better use of universal services Another manager said ‘We need to focus now on
and builds on prevention strategies, reablement the other three Putting People First quadrants.’
services and similar – areas contained in the other And another said ‘The next phase will be a bigger
three quadrants. But the work touching each of change, and will rely on partnerships.’
these last three quadrants has tended everywhere
to be marginal to the major tasks involved in In many ways it is remarkable and heartening to
transforming the core business of Adult Social observe how much this core vision is shared. The
Care. There is a need to switch emphasis now. way people talked about it made clear that the
vision was one that they owned personally, not
Another way of describing this set of challenges is something that had been imposed. It has been
in terms of the issues faced by the ‘whole person.’ this sense of a shared vision that – as much as
Individuals live in families (often); they have anything – has enabled the Authority to take the
health care needs as well as social care needs; steps it has and it is encouraging to see progress
and these needs change as they move through continuing. However, there appears to be a
life. They make contributions to society – often consensus that the next stage will be even more
by having a paid job, and sometimes by engaging challenging, relying as it does on colleagues in

other agencies, some of whom do not yet share Care Service is clearly crucial in providing the sort
the vision in the wholehearted way that seems so of context that will make SDS functional for many
important. potential users: when someone is about to leave
hospital or has had some form of trauma or injury
Looking to the next two to five years, then, what this is not the time to be doing careful considered
are the challenges and what learning might support planning, or being creative about how
managers in the Borough draw on? to use a Personal Budget. Among other things, a
service of this kind provides a breathing space and
time for someone to recuperate and recover before
thinking about what comes next.
Prevention and reablement
There are other examples of prevention in
Hartlepool’s Multi-Link Team describe their work evidence: a leaflet on Ageing Well in Hartlepool
as follows: provides a series of tips aimed at helping people to
stay fit and active into later life; and information
‘The Multi-Link is a joint team with Hartlepool provided for people with learning difficulties and
Primary Care Trust and North Tees and Hartlepool those with physical disabilities places emphasis on
NHS Trust, providing rehabilitation, recuperation the importance of getting and maintaining a paid
and time-limited therapeutic support for people job, rather than relying on health and social care
needing timely discharge from Hospital or services.
alternatives to unnecessary hospital or nursing /
residential care admission. These services and messages, important though
They provide support and assistance to enable they are, remain relatively modest. They show
people to maintain their independence within that the Local Authority understands people’s
their own home, or to assist in discharge from deep need to stay in their homes and become or
surrounding hospitals or care homes, permanent remain active, but to date it has only been able
residential or nursing home care. to give this need relatively limited attention. This
The team will give you advice on how to cope is much the same critique as that leveled at the
with your illness or disability, or provide you with attempts by the NHS to promote genuine public
appliances, equipment or telecare technologies health policies: that the organisational culture and
to help you do things more easily. You will all be orientation of the NHS is towards treatment (a
following a written care plan, which alters as you ‘national sickness service’) rather than prevention.
improve. Shifting such a culture and orientation is far from
Each person’s progress is different and it is difficult easy.
to predict how long recovery may take. Each service
is for a set period, but you may require ongoing or What in outline might a genuinely personalised,
alternative support. preventive health and community strategy look
After assessment by a member of the team, like? It might aim to achieve:
your needs are discussed with you and you will be
offered the most suitable choice of care support. A strategy that builds from the bottom up –
Once you are happy, you will be given a copy of that is to say one that identifies the assets in
your care plan. evidence in the different communities in the
Some people will not need any further help locality and nurtures and develops these.
following rehabilitation, but some might need to A strategy which links with other
have a different programme of rehabilitation, or Government plans for the local economy
long-term services to help them stay in their own – particularly plans for economic and
homes. If ongoing help is needed, a Care Manager social regeneration and for tackling social
will arrange this for you.’ exclusion. Social care supports and the
energy and initiative of Personal Budget
Multi-Link works alongside a Rapid Response users should be central – not marginal – to
Team, part of the Intermediate Care Service these plans.
which provides short term nursing, social and A strategy for working-age people, centred
therapeutic care for people leaving hospital and on real jobs. In Control has written about
aims to prevent new admissions. The work of this area and is offering a product to local
Multi-Link and their colleagues in the Intermediate authorities to help them develop a local

programme so that Personal Budget users brought its challenges – as the IBSEN evaluation
can make best use of their money to get and noted with particular regard to older people – it
keep a job (see more below). has proved of great benefit for many individuals,
A strategy underpinned by developments and has enabled In Control to develop a model of
in information technology which makes active citizenship for all.
the most of opportunities offered by new
technology in public libraries and initiatives In Control in fact believes that Self-Directed
to promote information literacy. Support and the values which underpin it apply
A strategy that is fun and which promotes through the whole of life.
mental and physical health – one that:
builds on the vibrancy of the town and its This term has two inter-related meanings:
constituent communities; and helps people
celebrate difference and diversity through ‘Whole of life’ in the sense of all aspects
local projects, enterprises and festivals and of someone’s life: education and personal
through imaginative use of their leisure growth, work, leisure, family, friends and
time. home.
A strategy that has universal services at its ‘Whole of life’ in the sense of all stages of life:
heart. The norm should be that citizens who from pre-conception to death.
use social care services will receive support
to use the same services as everyone else in In Control has now begun thinking about the
the community. The exceptions will be those needs of those children and families who need
people with very special needs, some of additional support. Nic Crosby and Simon Duffy
whom will remain partly reliant on specialist have written about this in a paper13 which argues
or targeted services. that there are four essential elements to SDS that
A strategy that is appropriate to all ages apply just as much to children and families as they
and socio-economic groups. Such a strategy do to adults.
seems particularly important given the very
specific demographic and economic profile These elements are:
of the Borough (outlined at the front of this
report). 1. Safeguarding – keeping people safe from
harm
Setting out the bones of a strategy of this sort 2. Resource allocation – creating explicit rules
is relatively easy: making it coherent, getting for setting budgets
all concerned to own it and making it live and 3. Planning together – enabling families to lead
breathe is a greater challenge. planning, with support
4. Outcomes focus – monitoring services in
terms of what they actually achieve.
Whole of life They go on to say that ‘This approach has the

further benefit of moving us towards a model in
In Control began its work in 2003 in adult social which families can use an integrated budget –
care. This approach was pragmatic, a response one which combines funding from health, social
to demand and an organic process that built on care and education. This Individual Budget can
ideas and energy from people in adult social care then be managed to deliver child-centred support
departments and their allies in many parts of the in a way that: locates leadership in the most
country – not least Hartlepool. In Control, as a appropriate place; involves all those who love and
project of Mencap began with a focus on working- care for a child; integrates support in a way that is
age people with learning difficulties. In the last personalised and child-centred; and maximises the
three years or so, it has consciously extended its efficient use of the limited resources available.’
scope to others: those with physical disabilities
and sensory impairments, people with mental The case for integrated funding is based around
health issues, people with alcohol or substance the success of a process that moves from budget
misuse problems, the street homeless, and allocation to planning through to a review of
particularly to older people. Whilst this extension progress toward outcomes, specifically the Every
of the technology of Self-Directed Support has Child Matters outcomes.

These outcomes are as follows: Real Wealth provides a wider perspective on the
resources that a family can draw on including:
Stay safe their own strengths and skills; their connections
Be healthy with family, community and others; their
Make a positive contribution understanding of the world they live in and
Achieve economic well-being ability to access information about the world and
Enjoy and achieve. what they need; and their physical and mental
resilience.
For example: health outcomes might be
delivered through an exercise programme at
school; relationships developed within the
school support social inclusion and participation
in the life of the local community; parents
are included and involved in defining these
outcomes wherever possible and appropriate.
Nic Crosby and Simon Duffy argue that ‘By
specifying such outcomes, rather than setting
targets for services, it becomes much clearer
that nothing useful can be achieved without the
combined efforts of the family...community and
professional services. Personalisation is essential
because it is only by working with families that
these outcomes can be achieved.’ The paper
goes on to give real-life examples showing how Real Wealth
people’s lives have been transformed by this
approach. The paper then sets out the remaining, not
inconsiderable, challenges to achieving each of
If outcomes are the goal and Self-Directed Support the four elements in ways that are consistent and
the operating system then there also needs to be accord with key values – namely developing a
an understanding of where the child and family personal response centred on an individual child
are starting from. In the paper, Crosby and Duffy without them becoming ‘stuck’ with unhelpful
introduce the concept of ‘Real Wealth’. In a similar traditional services.
way to the four quadrants of personalisation
outlined as part of Putting People First, Real Wealth It concludes with the optimistic statement that:
places the Personal Budget in context as only one ‘As we move towards greater personalisation, we
small part of the wealth a child and family have to are discovering that its focus on the holistic needs
draw on: of the individual offers a new means of overcoming
the barriers between services. We can
even begin to identify a new long-term
vision for consistent and meaningful
support across the age range and the
increased use of integrated funding in
Individual Budgets.’
These changes are beginning to

impact in many parts of England:
by August 2009, 35 children’s
services were members of the Taking
Control Children and Young People’s
Assets – One part of Real Wealth Programme and eight had already begun to
make allocations. In August 2009, there were
‘Support will not always consist of services 95 live Personal Budgets for Disabled Children
that are paid for. Support can also come from and, if combined with those managed for a
networks, friends, extended families and child or young person by a Budget Holding Lead
community links.’ Professional, there are just over 1,000.

What are the issues and committed leadership and is well placed to take
prospects in Hartlepool? this agenda forward more comprehensively than

many authorities that are still working to generate
energy and commitment across services.
Nicola Bailey, the Director, clearly recognises
progress in SDS for children and young people as
a major issue, listing it as one of the four strategic
challenges the Borough now faces in taking Health
personalisation forward. A forthcoming re-structure
of responsibilities within the Council in late 2009 Staying in Control is In Control’s health
is bringing the Adults and Children’s Departments programme. It is a learning community focused on
together under one roof. This will inevitably lead to a specific task: exploring how the personalisation
questions about the strategies and the focus of the model we are using in social care can be tested
new Department. It would seem probable, given and amended in health care. The programme
national policy direction and the successes to date starts from the important premise that this
in Adult Services, that SDS will become the norm approach is not appropriate for all aspects of
across the whole joint social care department. This health care – for example in emergency situations
will bring a number of challenges. or circumstances where surgery or other invasive
treatments are indicated.
These will include:
The programme began with the recognition that
Organisational cultures are, inevitably, very people do not divide their needs between boxes of
different in children’s services. ‘social care’ and ‘health care’. We all have a mixture
Developing, testing and introducing an of needs and strengths and our support and
appropriate Resource Allocation System for treatment needs are distributed in a blurred way
children and families. across the sometimes artificial divisions which
The issue of different funding streams: as result from the way organisations have come into
noted, there is some good work that has being and evolved over time.
already taken place in Adult Services in the
Borough but this issue becomes even more Early in 2008, In Control invited all Primary Care
pressing and complex when the wider needs Trusts in England to consider coming together as
of families are factored in. Staying in Control (Health) to think through and
Defining outcomes in ways which make sense create a first iteration of the operating system for
locally. personalisation in Health. Hartlepool was one of
Development of a support-planning 37 PCTs (including three Care Trusts) which joined
infrastructure that suits the needs of families. the programme alongside their local authority
Issues of safeguarding and child protection. partners. Self-Directed Support is a complex, well-
Issues about the transition process from developed, whole system approach specifically
Children’s to Adult Services. designed to reform social care. It works well since
Care leavers and their particular needs. it leads to better decision making.
The role of social workers and how to
make best use of the skills of these and The nature of decision making in health care is
other professional and clinical staff with a different, as are:
background in children’s services.
The role of schools and how they see the history and legislative context
personalisation. the number of professions and professionals
Real family wealth and what this may mean involved
in practice. the existence of deep professional and
Developing all of the above in the context of technical expertise which cannot be easily
and alongside the diverse communities of the made transparent
Borough. ‘health rationing’ which is much more
complex and multi-faceted than rationing in
These issues are common across the existing social care and is underpinned by a continuing
membership of the children’s programme Taking political commitment to the notion of ‘free at
Control. However, Hartlepool has an informed and the point of delivery.’

For these reasons we must respect the differences It should be clear then that, in some regards, SDS
and work within them. People who have an in Health is at the very start of its journey. At the
ongoing mix of health and social care needs may time of writing it remains unlawful for a PCT to
well want choice and control over their health care use its resources to grant a Direct Payment or a
as well as their social care. In fact, most people do Personal Budget and, although in many places
not differentiate: people want to be in control of clinicians and managers have discovered that
their lives and few are concerned with the ways in they can achieve the same ends via payments
which Government and public organisations divide to provider organisations that are for specific
these things up. In joining the Staying In Control individually tailored and agreed plans written
programme, Hartlepool Borough Council and by the individual, or by encouraging the creation
Hartlepool Primary Care Trust are signalling that this of Independent Living Trusts, there remain real
is understood and the issue is seen as a local priority. systemic barriers that can put off all but the most
Government policy shifted markedly in 2009 and, determined. In Control’s work with its Health
following Lord Darzi’s report, High Quality Care for Members is still in its early stages and we have
All, the Department of Health has now launched much to learn before a robust model of Self-
its own Personal Health Budget Pilot programme, Directed Support in Health emerges. The work
which will be backed in time by legislative changes over the last year, however, has enabled us to draw
to enable some of the Pilot PCTs to pass funds together the discussion paper as the first iteration
directly to individuals in certain circumstances. in a process of learning which is created and
shared by our members.
The members of Staying in Control committed to
contributing to a first discussion paper to address In Hartlepool, the Borough Council has been
some of these challenges. This paper, Citizenship working closely with colleagues in the PCT to
in Health Self Direction Theory to Practice by deliver a range of ‘low level’ services to promote
Rita Brewis and Simon Duffy was published in physical and mental health across the borough.
July 2009. This report describes ‘a whole-system One example is an allotment project which is a
approach designed to fundamentally change collaboration between the Council, PCT, MIND and
the relationship between the NHS (as part of the other third sector groups. This is just one example
welfare state) and the population or citizens...Self- of how good partnership working can deliver real
Directed Support has a purpose... to enable full outcomes that benefit the whole community.
citizenship for everyone and thereby contribute
to the creation and sustaining of healthier, more As with the work with children and families, the
cohesive communities.’ health sector in Hartlepool presents a number of
cultural and technical challenges, which the local
The report underlines that, for the approach to standard-bearers for personalisation will need to
work successfully in health care, it needs to find come to grips with over the coming years if local
its place: ‘We are not trying to change an entire people are to feel that they have the opportunity
NHS system but to consider some aspects where for choice and control in all aspects of their day-to-
doing things differently could be directly beneficial day lives.
for individuals, families and professionals, and also
for the tax-paying public in terms of making best
use of public money. This report gives an analysis
of how we might weigh up where it is useful to Work
consider change and where it is useful to cherish
what we have.’ Getting and keeping a real job is good for
everyone: the individual who has a job is
It is not then a question of simply transferring usually happier, healthier and better off. The
experience and learning from social care to community is more coherent and participative
health care: ‘We will draw here on our learning and employers and the local economy are likely
from within Self-Directed Support in social care to be more prosperous. In Control promotes real
whilst acknowledging that there are fundamental jobs for Personal Budget users through a series
differences between health and social care which of accessible Factsheets on its website. These
make this learning, whilst useful, insufficient seek to guide people through the basic steps
without further exploration and debate specifically involved in thinking about, finding and keeping
within the NHS.’ a job. In Control has also now initiated a new

programme – the Real Jobs Programme –which Employment issues are of particular concern in
offers local authorities proven techniques of former industrial areas such as the northeast
supporting those traditionally excluded from of England where unemployment is high. In
the workforce. August 2009, unemployment in the region was
over 9%, the second highest in the UK. Economic
A ‘real job’ as defined by In Control is one in regeneration is an important aspect of the
which someone is employed by a company or work of Hartlepool Borough Council through its
organisation or is self-employed. The person is Economic Development Business Support Unit
paid. and, in particular, the Working Solutions section
which ‘helps Hartlepool people and businesses
A real job is also one that: to maximise employment and self-employment
opportunities through innovative training and
helps the person to meet their life-goals and recruitment solutions.’ Interestingly, one of the
aspirations supports on offer is a ‘flexible fund... a grant of up
is valued by managers and colleagues to £50 to support residents who are going into work
gives the person a chance to progress, if they and need a small amount of support to secure the
wish to job.’ So the notion of a (small) Personal Budget
does not assume that every person wishes to may be already in place.
progress
has similar hours and times at work as other The Borough now needs to capitalise on this
employees at the company or in similar jobs initiative, to build connections between the social
gives employment rights and the other entrepreneurs mentioned above and citizens
benefits accorded to colleagues and others in with Personal Budgets and with ideas for what
similar jobs. they want and need; and perhaps to consider
developing some of the other specific employment
Given the current poor prospects in the economy services mentioned above.
and the difficulties many non-disabled people
have in finding and keeping work, creating
pathways to a real job presents a significant
challenge. Many local authority social care Community 14
departments have seen work and jobs as
marginal to their core business, and in those The necessity for specific action to build the
cases where authorities have paid attention capacity of local communities to support those
to employment, they have often promoted of their members needing ‘social care support’
traditional service models such as sheltered has been an important part of In Control’s focus
workshops or supported employment schemes. since its inception. The priority in the early years
These do not meet the minimum criteria for a of In Control was very much on putting in place
real job, and they are unlikely to enable people to a technology for Self-Directed Support so that
get and keep a job. local authorities were in a position to provide
support to individuals in the form of Personal
In Control regards real jobs as fundamental Budgets rather than as Direct Services. Since
to the future success of its mission to nurture that technology has been available, work on
active citizenship rooted in community life: community capacity has come to assume greater
it goes to the heart of the question of what prominence.
it is that society might expect of its disabled
citizens, and of what those citizens might expect This has been welcomed in many local authorities
in return by way of resources and support. including Hartlepool, where there is a strong
In Control’s Real Jobs programme offers local history of community development. As Sarah Ward
authorities the opportunity to work on some says: ‘We are facing the larger Putting People First
of the fundamental elements: information, agenda now. We need to think about the impact
planning, job search and customising support. on community. There is a real community spirit in
The Programme also offers specific support to Hartlepool with 500 plus community organisations.
commission a customised employment service Our work with Connected Care has meant we have
for citizens with disabilities and to work on self- had to think about all of this. We need to give some
employment and Family Led Jobs. thought to how we make the most of this.’

The Connected Care initiative is an important Ray Harriman gives the example of a family he has
example of what can be achieved. It is based in been working with. There are real issues with the
one ward in the Borough, Owton, which has a children. ‘The elder sibling has had frequent run-ins
population of 7,000. Levels of deprivation are high. with the criminal justice system, the youngest has
The initiative is led by the national organisation, problems at school, there are issues around benefits
Turning Point. The central driver of the project is advice, real issues of poverty, debt – those sort those
the notion of building capacity from the ground up. things. We often see neighbourhood disputes and
the consequences of a dire lack of suitable housing -
The initiative was funded by the Borough Council, seven people in a three-bedroom house.’
the PCT and the Working and Neighbourhoods
Fund. Housing Hartlepool introduced a new system
through which families can now bid for a house.
It was described as it began in 2006 as comprising Providing a culture where local agencies – the
a number of major elements: Housing Department and others – are able to
think outside the box has been one of the major
A special team of navigators. This team will successes of Connected Care.
listen to members of the community to
identify their problems and concerns and Another example: a young lady came to see Ray
guide and support them and help link services with her mum. She was twenty-four and had four
to meet their needs. Team members were to children – three of whom were in care. ‘She was
be recruited from the community. coming off the top of very bad heroin addiction, no
The development of a range of low level house – horrendous. Now she’s got a three bedroom
support services that focus on maintaining house, her children back – we provide ongoing
independence. support, advice and guidance. She’s off drugs, works
A ‘social enterprise vehicle’ to deliver the for the local residents’ association, has done a level
above. The enterprise to be managed by 2 youth work qualification and will go on to do a
residents and local community organisations, foundation degree next year. She now gives advice
with statutory agencies as stakeholders. to young people about drugs and alcohol abuse –
A service co-ordinator to manage the service and has a solid relationship with her partner.’
and ensure it meets the needs of residents.
This person was to be recruited locally. Ray attributes these successes to having cultivated
good working relationships with partners. ‘It
The project sought to address some of the barriers wasn’t all down to the level of support we were
which local people saw as holding back their able to give her – we didn’t do it on our own – we
community. These barriers were identified and pulled in other agencies. A lot of what it’s about
specified through a Community Audit, which is helping people know what’s out there - getting
asked people about how services might be better people in as part of the solution...providing joined
organised to meet their needs. Themes that up services.’
emerged included: information, choice, access to
services, continuity and communication between The Borough Council is now beginning to think
services, and issues in relation to the workforce. seriously about prevention. As Principal Finance
Ray Harriman, a Connected Care navigator says Manager/Transformation Lead, Jeanette Willis
‘We often read about joined up services – but the puts it: ‘We’re starting to ask everybody as part
reality is that they are often poorly delivered. So a of our standard assessment, what support could
big piece of work is with partners to look at how we have prevented them from needing social care.’
better align budgets.’ The Community Audit showed that it is often the
smallest things that are the most important. Ray
A statement made at the time suggested that: Harriman describes this as being: ‘about changing
‘Connected Care is not separate from the wider a light-bulb – so the older person doesn’t go on to
social and economic contexts in which people have a fall and end up in hospital ...so we’re talking
live their lives: Connected Care in fact needs to about low-level services.’
be delivered within this wider context. Initiatives
that tackle poverty and create employment Connected Care aims to develop services at a
and prosperity are an important component of community level. This has meant working with
Connected Care.’ many of the smaller local organisations and

commissioning them to deliver the services that ‘It is the way in which we use our wealth in the
people say they want. It has also meant providing context of the wider community within which we
the advice and support that makes this possible are situated which will shape the outcomes we
for small organisations – including help with achieve:
drawing up contracts and back office support.
The quality of family life in the community
To this end, Connected Care has recently set The associations, clubs, circles available
up Who Cares, a Community Interest Company, Social enterprises, charities, faith organisations
which is now beginning to commission services Business, commerce and economic
directly. The CIC’s directors are made up of environment
representatives of community organisations. Ray Public services, hospitals, schools and
says that this is ‘because we feel very strongly we emergency services
should keep ownership in the local community Law, regulations, democratic and judicial
– this is about empowering local community structures.
organisations – and ensuring that these are still
there’. It is important that we learn more about how wider
communities can enable or inhibit the extent of
Gerard Wistow, researcher and local councillor opportunities available for individuals, and how
in Owton, has written widely about Connected interventions also impact on communities.’16
Care.15 Many challenges have been encountered
– unsurprisingly, given the ambition and the This perspective fits well with Hartlepool’s
determination to find solutions that are local and perception of the wider challenge in relation
which go with the grain of local community. to community building. In summer 2009, the
Authority began a review of its Putting People First
For Sarah Ward and her colleagues in Hartlepool, strategy, led by its Scrutiny Committee. The review
the challenge now is to build a stronger is expected to focus initially on personalisation
relationship with the Connected Care pilot. Sarah in adult social care but Sarah Ward suggests
says ‘We could be making better use of having that this focus will also pick up the work the
the pilot there. For instance, it’s not uncommon Authority has been doing with other partners
for local social work team members to have to and communities: ‘A while ago, we got a group
“pend” certain situations – and in those cases, if we together including everybody with “community” in
let Connected Care know, at least whilst there’s a their job title. Hartlepool is a tiny authority but that
backlog within the system, they could keep an eye was still a lot of people. We began by conducting a
on the person’. mapping exercise to look at who’s doing what. Now
we’ve got to see what else is going on and how
Ray Harriman also sees this as a challenge: ‘We we can be better at linking together what we’re
don’t want to be another cog in the wheel – we’ve all doing...there are a lot of meetings happening
got to be something different from the Local around planning, regeneration, and around
Authority – we need to be able to respond to what neighbourhoods and community.’
people need. We need to be inside the system but
in our work we have to be able to stand outside the This understanding is in tune with In Control’s
system. We’ve seen a massive change in people’s current priorities: ensuring that the real transfer
responses that we’re working to produce a big of power to people and communities brought
change from people in the voluntary sector too. The about by Self-Directed Support is strengthened,
question now is how do we align what we do better as the spark for a broader cross-authority and
with the system?’ multi agency strategy to grow and strengthen
communities.
Sarah Ward and her colleagues working on Self-
Directed Support are clear that they now need to In autumn 2009, In Control launched its new
look more closely at lessons from Connected Care Stronger Communities programme, with a wide
in Owton and from elsewhere. This determination range of national partners. The object of the
fits well with In Control’s renewed focus on programme is to explore how personalisation
community capacity. John Gillespie and Simon can play a part in wider efforts to build stronger
Duffy write about real wealth (above) in this and more resilient communities, and how this
regard: approach might impact on local authority and

Local Strategic Partnership agendas. It will use a Key learning points from
variety of approaches including strategic support,
workshops and assistance with evaluation Chapter Four
exercises to support participating authorities.
1. Self-Directed Support needs to be seen as one
In Control has already begun by encouraging strand in a much wider agenda. That agenda
and showcasing the development of a number is about the promotion of citizenship and
of practical approaches to aid community community.
development. These have included Small Sparks 2. Adult services departments must put in place
(small grants to individuals who want to carry specific services and schemes to prevent
out a small community project), Local Area Co- people becoming in greater need. This is
ordination (staff with the job of building links particularly important for older people.
between individual and community), Partners in 3. Personalisation is about the whole of a
Policymaking (a national peer-support network person’s life, and adult services need to work
that promotes community-based ideas and with others, including those working with
initiatives) and Our Futures (formerly Plan UK, an children and families and those working on
approach to developing long-term community/ promoting the health of the local economy.
peer support for disabled people). These are not 4. Personalisation concerns health care and the
isolated initiatives, but part of a wider move to NHS as well as social care. But in health there
ground personalisation in the real day-to-day are different concerns and issues and we need
experience of people living in the diverse villages, to give these concerns and issues focused
towns and cities of the UK. attention.
5. Real jobs are important to people and local
How far the programme or the approaches listed authorities need to develop the capacity to
might have an impact in Hartlepool, it may be too help Personal Budget users to get and keep
early to say. The challenge though is clear – to link them.
the excellent work in developing a local culture 6. Personalisation will only succeed if we build
and infrastructure for SDS and Personal Budgets the capacity of communities to support
with the talent and strength evident in the many people and ensure that we do not focus
and various communities of the Borough. exclusively on citizens as if they were isolated
and disconnected individuals.
7. Personalisation must draw its energy from the
community-up. The Connected Care initiative
in Owton provides an example of what this
might mean in practice.

Acknowledgements
Acknowledgements and last words from
Nicola Bailey
This report reflects a key stage on Hartlepool’s journey. We would not have
been able to reach this point without the dedication and motivation of both
the key personnel and citizens of Hartlepool. Our sincere thanks go to the
many contributors to this report (detailed below) and to Andrew Tyson for his
coordination and authorship.
I would like to acknowledge the following Jeanette Willis, Principle Finance Manager /
people for their support on our journey to the Transformation Lead
transformation of Hartlepool: Neil Harrison, Strategic Commissioner – Working
Paul Walker, Chief Executive Officer of Hartlepool, Age Adults
for his support to the transformation. Phil Hornsby, Strategic Commissioner – Older
Ged Hall, Portfolio Holder – Adult and Public People
Health Services. Geraldine Martin, Head of Adult Services
Ewen Weir, Neil Harrison, Sarah Ward, Kath Millican, (Acting) Head of Adult Services
Jeanette Willis and others for their dedicated Terressa Noble, Social Care Officer
implementation of Self-Directed Support.
Stephen Smith, Senior Finance Officer
Oldham Metropolitan Borough Council for sharing
Ewen Weir, Director Newcastle City CouncilC
its learning so freely, warts and all!
Rita Brewis, In Control Lead for Health
Moveable Feast for their inspirational,
entertaining education which kick-started internal Nic Crosby, In Control Lead for Children and Young
culture change. People
Julie Stansfield, Managing Director of In Control, John Gillespie, In Control Lead for Stronger
for her role as Site Support, critical friend and Communities
advisor to Hartlepool. Henry Iles, In Control Design & production
John Waters of In Control for both his RAS and Carl Poll, In Control Editor
evaluation work.
Julie Stansfield, In Control Managing Director
Steve Jones for helping us to think wider than
Ray Harriman, Turning Point
adult social care.
Carol Hall, A4E
The report is intended to record the achievements

Contributors to this report
to date in Hartlepool, to make clear some of the
Nicola Bailey, Director of Child and Adult Services challenges still to be addressed and to provide
ideas and inspiration for others. If you have any
Carole Keay-Bolton, Principle Practitioner, Social comments about any of these subjects, please
Care Transformation Team contact Andrew Tyson at In Control:
Sarah Ward, Social Care Transformation Manager andrew.tyson@in-control.org.uk

Endnotes
1. Alimo-Metcalfe, B and Alban-Metcalfe, J. (undated) The Transformational Leadership Questionnaire (Public

Sector Version)
2. See http://www.in-control.org.uk/evaluationreports
3. S. Duffy (2003), Keys to Citizenship, Paradigm
4. The In Control Phase Two report is available at http://www.in-control.org.uk/site/INCO/Templates/

General.aspx?pageid=70&cc=GB
5. The Individual Budgets Pilots Projects Evaluation (IBSEN) report is available at

http://php.york.ac.uk/inst/spru/research/summs/ibsen.php
6. The guide can be downloaded from:

http://www.in-control.org.uk/site/INCO/Templates/General.aspx?pageid=610&cc=GB
7. See details on the In Control website at http://www.in-control.org.uk/home
8. Tyson, A. (2009) Self-Directed Support: Social Workers’ Contribution, In Control website
9. Martin, G. (2008) Hartlepool Borough Council: A social Care Paradigm Change Process. An investigation
into the impact of Self-Directed Support (SDS) on the social workers of Hartlepool Borough Council
with recommendations to facilitate collective meaning within the transformational change process. A
dissertation submitted to Teeside Business School, University of Teeside for the Degree of Master in
Business Administration.
10. NAAPS is a UK charity established to represent the interests of all those involved in delivering very small,
individualised, community based services such as Shared Lives (formerly known as Adult Placement).
See: www.naaps.co.uk
11. NAAPS and Department of Health (2009): Supporting Micro-market Development, Key Messages for local
authorities, http://www.dhcarenetworks.org.uk/_library/Resources/Personalisation/
Personalisation_advice/SSMSCSEkeymessages.pdf
12. In Control, in partnership with Valueworks, has developed an online marketplace, shop4support, as a way
of supporting the growth of a diverse provider market. See: www.shop4support.com
13. N. Crosby and S. Duffy (2009), A Whole Life Approach to Personalisation, In Control website
14. Thanks to John Gillespie of In Control and staff of the Hartlepool Connected Care project for the quotes
and other information used in this section of the report.
15. For example, see Wistow, G and Gallaghan, G, (2008) Journal of Integrated Care 16 (2): Connected Care in
Hartlepool Re-visited, Can a Holistic and Community centred approach survive Implementation?
16. Gillespie, J and Duffy, S (2008) In Control website: Community Capacity and Social Care.

Appendix
Who used Self-Directed Support in Hartlepool?
This appendix provides a profile of Adults aged between 18 and 102 were allocated a
people taking up Self-Directed Support Personal Budget. The mean average age was 67.4.
Over half – 510 (62%) – of the people in the group
in Hartlepool. In the course of the Self-
were over 65 years of age. On average, people with
Directed Support process in Hartlepool, learning disabilities were the youngest group and
key information was collected about had the biggest age range (between 18 and 80).
Personal Budget recipients. Information The average age and age range of people with
was gathered from self-assessment physical disabilities and mental health needs were
very similar.
questionnaires and from the Resource
Allocation Process. A snapshot of this
information was collected in June 2009. Social care groups
The data has been aggregated and is
People completing the assessment questionnaire
summarised here. The group comprised
were from a wide range of social care groups.
819 people, all of whom completed at Older people were by far the biggest group and
least one self-assessment questionnaire. made up over half (61%) of the whole group.
Questionnaires were completed over an 600
18-month period between 22 November 500
2007 and 29 May 2009. 400
300
Age 200
100
100 0
Learning Disability Older People Mental Health Physical & Sensory
80 Disability
60 Figure 3. Number of people by social care group

40
20
Gender
0
1 101 201 301 401 501 601 701 801 There were significantly more women than men:
526 (64%) women, 293 (36%) men. Women
Figure 1. Age of people outnumbered men in all groups except learning
disability. The difference across mental health and
100 physical disability groups was insignificant.
80 Gender
1000
60 800
600
40 400
200
20
0
Everyone Older People Learning Mental Health Physical
0 Disability Disability
OP LD MH PD
Male Female
Figure 2. Age across social care groups Figure 4. Uptake by gender

Needs Available social support.

To calculate a reasonable allocation for a Personal The level of available social support was measured
Budget, the assessment questionnaire measured to adjust an initial allocation based on the needs
level of needs and available social support. score. Allocations were adjusted by one of four
levels: 0%, 30%, 60%, or 90%. The average level
The level of needs was measured across a number of adjustment across all groups was 28%. Older
of domains. The maximum possible score was 100. people had the highest average adjustment figure
of 32%.
The domains and possible maximum score for
each were as follows: 35
30
complex needs and risks (30) 25
meeting personal needs (38) 20
meals and nutrition (10) 15
work, learning and leisure (4) 10
making important decisions about life (4 5
being part of the local community (10) 0

essential family / caring role (4). Older People Learning Disability Mental Health Physical Disability
There was a broad range of scores across all social Figure 6. Level of adjustment for available support
care groups. People with mental health needs across social care group.
had the smallest range, with both the highest
minimum score and the lowest maximum score.
People with learning disabilities had the highest Allocations
average score with 64.3, followed very closely by
people with physical disabilities: 63.6. The average For each individual going through the Self-
overall needs score was 57.7. Directed Support process, it was possible to
identify three significant points that led to an
actual Personal Budget allocation:
Initial allocation: the amount the RAS

determined to be reasonable if no other
support were available to the person.
Adjusted allocation: the amount deemed
to be reasonable having taken into account
other support systems. This allocation was the
amount the person could use in their support
planning.
Figure 5. Average needs scores across social care Approved amount: the amount that the
groups. Authority agreed once a support plan had
been produced and agreed.
More detail about the domains is presented in the
table below. Data was available at all three points for 548
people.

1. Complex needs and risks

In the past I have done things that could hurt me or others or I’ve done things that were
Low 9.6% difficult for other people. But there is no problem now. [or ] This section is not relevant to me
as I do not have any needs in this area.
Some things I do, other people find difficult. I have help to manage this so there’s no real
Medium 26.7%
danger to me or other people
I do not know when I am in a situation where I can be hurt or when I can hurt others. [Or ] I
High 60.9% am not able to maintain personal safety as I have no control over my environment due to a
physical disability
2. Meeting personal needs
None 7.2 % I am able to meet my personal needs and do not require any support in this area.
I am able to meet my personal care needs with occasional physical / gestural / verbal
Low 22.8%
support.
I need significant physical / gestural / verbal support from another to meet my personal
Medium 40.3%
care needs.
I need full intimate support to meet my personal support needs. I need this from someone
High 29.7 %
else.
3. Meals and Nutrition
None 7.2% I do not need any help in this area.
Low 20.6 % I need some help with preparing meals.
Medium 61.9% I need all of my meals provided or prepared for me by someone else.
I need total support from someone else to help me to prepare my meals and to help me to
High 10.3%
eat and drink.
4. Work, Learning and Leisure
Low 12.3% I do not need any help in this area.
I have a work role / job / am enjoying my spare time. This gives meaning and purpose in my
life and I need some support to keep this.
Medium 52.4%
[Or] I need support to take part in work, leisure or learning. I need more support to get more
opportunities for work, learning or leisure.
I need support to take part in work, leisure and learning and I have few or no chances for
High 35.3%
work, leisure or learning in my life.
5. Making important decisions about life
None 9.5% I do not need any support in this area.
I need support to make decisions but I have full control over all day-to-day and life-changing
Low 26.9 %
decisions.
I need support to make decisions. I have control over most day-to-day decisions but less say
Medium 41.5%
in life-changing decisions.
I need support to make decisions about my life, but most day-to-day decisions are taken by
High 22.1%
others on my behalf.
6. Being part of the local community
None 3.2% I don’t need any support in this area.
Low 25.8% I do things I want to in my community. I need support to continue to do these.
Medium 24.4% I need support to do more in the community.
I need someone to support me closely to help me to make connections with people in the
High 46.6%
community where I live because I have difficulty making friends or get very lonely.
7. Essential Family / Caring Role
None 91.6% I do not need any support with my parenting / caring role or am not a parent.
Medium 3.7% I need some support with parenting tasks, or some support in my role as a carer.
High 4.8% I need lots of support with many parenting tasks, or a lot of support in my role as a carer.
8. Available Social Support
High 1.3% I am able to get nearly all the help I need from my family and friends.
I am able to get much of the help I need from family and friends and have or need
Medium 21 %
occasional paid help.
I am able to get only some of the help I need from family and friends and need significant
Low 48%
paid support.
I get little or no help at all from family and friends
None 29.5%
[Or] I need 24 hour / 7 days per week paid support.

Allocations to people with learning disabilities Responses to the needs

were significantly higher than to other groups. The
average approved allocation was £8,457 – slightly
questionnaire
lower than the average adjusted allocation (the Very few, (1.3%) of the group, said they were able
amount offered): £9,167. to get nearly all the help they needed from their
£25,000
family and friends.
£20,000
Nearly two thirds (60.9%) said they had a high
level of need in relation to risk.
£15,000
Approved The great majority of the group said they did not
need help with parenting or caring roles.
£10,000 Adjusted
Initial
£5,000
£0 Needs domains
Everyone Older Learning Mental Physical
People Disability Health Disability
See the table on previous page.
Figure 7. Average allocations


This report is an account of rather they are a critical self
our work and the things we evaluation of our progress to
believe we have learned by date. The findings represent our
implementing Self-Directed best attempt to understand
Support in Hartlepool Borough and report the things people
Council. The findings are not have said to us about their
intended to represent the experience of taking control of
results of an academic study, a personal budget.
Hartlepool Borough Council, Adult Social Care Department:

Tel: 01429 266522
Email: socialcareservices@hartlepool.gov.uk
Website: www.hartlepool.gov.uk
Address: Civic Centre, Victoria Road,
Hartlepool, TS24 8AY
In Control Partnerships
Website: www.in-control.org.uk

Ic Hartlepool Report 2006-2009

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Self-Directed

PHOTO: ANDREW TYSON

Hartlepool Borough Council | In Control Partnerships

Hartlepool Borough Council | In Control Partnerships

Self-Directed Support in Hartlepool 2006-2009 © In Control Partnerships

All rights reserved.

No part of this book may be reproduced in any form without

Document title published by In Control

This document is available for download

Hartlepool Borough Council | In Control Partnerships

Foreword by Nicola Bailey and Julie Stansfield ���������������������������������������������������������� 1

Chapter One: Preparing for Self-Directed Support ����������������������������������������������� 4

Chapter Two: The tools for transformation ���������������������������������������������������������������� 13

Chapter Three: Changes to the way support is provided ���������������������������� 18

Acknowledgements and last words ����������������������������������������������������������������������������������� 35

Appendix: Who uses Self-Directed Support in Hartlepool?����������������������� 37

Hartlepool Borough Council | In Control Partnerships

Hartlepool Borough Council | In Control Partnerships

This is a report of Hartlepool’s progress in developing Self-Directed

Nicola Bailey, Director of Child and Adult Services, Hartlepool

Hartlepool Borough Council | In Control Partnerships 1

2 Hartlepool Borough Council | In Control Partnerships

In Control's Critical Path to Total Transformation

Increased Skills for All

Develop the New Systems & Procedures Total

Reviewing, Learning & Sharing

Make the Care Management

Prevention & Reablement

Hartlepool Borough Council | In Control Partnerships 3

resource allocation; and a system for support 8

In other words, the picture in 2006 was of a 0

Digging a bit deeper, there were particular Hartlepool

4 Hartlepool Borough Council | In Control Partnerships

before 2005/2006 Everything else was spot-purchased.

There is little doubt that this pattern of

Hartlepool Borough Council | In Control Partnerships 5

6 Hartlepool Borough Council | In Control Partnerships

Hartlepool Direct Payments uptake third highest in England

Direct Payments take-up: the top 10 authorities

developed DP policies.  

Direct Payments and ILF take-up

Hartlepool Borough Council | In Control Partnerships 7

In Control’s Transformation Jigsaw

8 Hartlepool Borough Council | In Control Partnerships

Hartlepool Borough Council | In Control Partnerships 9

10 Hartlepool Borough Council | In Control Partnerships

Finance Manager/Transformation Lead, reiterates of information gathered from this analysis is

As they allocated real resources to people, they 

were able to experiment with the underpinning 

systems and processes and think through the 

difficult outstanding issues – including the rules 

and regime for charging for non-residential 

services. Jeanette Willis sees the Hartlepool 

Contributions Policy as a major achievement – one 

which breached a significant barrier: ‘SDS meant 

we clearly needed to change the charging policy. itial j p

Practicalities dictate that if we assess someone for Personal Budget allocations

Hartlepool Borough Council | In Control Partnerships 11

12 Hartlepool Borough Council | In Control Partnerships

Economic systems process to manage discharges from hospital (see

Hartlepool Borough Council | In Control Partnerships 13

national thinkers, policy makers and leaders,

procedures local politicians and community leaders

Hartlepool Borough Council | In Control Partnerships

Foreword by Nicola Bailey and Julie Stansfield �� 1

Chapter One: Preparing for Self-Directed Support �� 4

Chapter Two: The tools for transformation �� 13

Chapter Three: Changes to the way support is provided �� 18

Acknowledgements and last words �� 35

Appendix: Who uses Self-Directed Support in Hartlepool?�� 37

Hartlepool Borough Council | In Control Partnerships

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